Provider Demographics
NPI:1407838766
Name:SONGHORIAN, MEHRI (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHRI
Middle Name:
Last Name:SONGHORIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 CROYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1639
Mailing Address - Country:US
Mailing Address - Phone:516-829-1736
Mailing Address - Fax:718-592-3844
Practice Address - Street 1:59 10 JUNCTION BOULEVARD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-760-4221
Practice Address - Fax:718-592-3844
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196191204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
500192Medicare ID - Type Unspecified
NYG09462Medicare UPIN