Provider Demographics
NPI:1487822375
Name:MOKHTARIAN, FOROOZAN (MPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:FOROOZAN
Middle Name:
Last Name:MOKHTARIAN
Suffix:
Gender:F
Credentials:MPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNY STONYBROOK 4603 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:SUITE 12-3
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933
Mailing Address - Country:US
Mailing Address - Phone:917-518-1319
Mailing Address - Fax:718-635-7088
Practice Address - Street 1:SUNY INCUBATOR 4603 MIDDLE COUNTRY ROAD
Practice Address - Street 2:SUITE 12-3
Practice Address - City:CALVERTON
Practice Address - State:NY
Practice Address - Zip Code:11933
Practice Address - Country:US
Practice Address - Phone:917-518-1319
Practice Address - Fax:718-635-7088
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMOKHF1247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician