Provider Demographics
NPI:1437615093
Name:HEDAYATI MEDICAL PC
Entity Type:Organization
Organization Name:HEDAYATI MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDAYATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-628-4946
Mailing Address - Street 1:237 E 149TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-1863
Mailing Address - Country:US
Mailing Address - Phone:718-585-3700
Mailing Address - Fax:718-585-4700
Practice Address - Street 1:237 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-1863
Practice Address - Country:US
Practice Address - Phone:718-585-3700
Practice Address - Fax:718-585-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology