Provider Demographics
NPI:1467642231
Name:BEHNAM, MAHMOOD
Entity Type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:
Last Name:BEHNAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 N MAIN ST
Mailing Address - Street 2:REFUAH HEALTH CENTER
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1960
Mailing Address - Country:US
Mailing Address - Phone:845-354-9300
Mailing Address - Fax:845-354-4298
Practice Address - Street 1:728 N MAIN ST
Practice Address - Street 2:REFUAH HEALTH CENTER
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1960
Practice Address - Country:US
Practice Address - Phone:845-354-9300
Practice Address - Fax:845-354-4298
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245052208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01421705Medicaid