Provider Demographics
NPI:1497742498
Name:TEHRANY, JAMSHID M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMSHID
Middle Name:M
Last Name:TEHRANY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 NEW DORP LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2324
Mailing Address - Country:US
Mailing Address - Phone:718-351-2426
Mailing Address - Fax:718-667-5161
Practice Address - Street 1:91 NEW DORP LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2324
Practice Address - Country:US
Practice Address - Phone:718-351-2426
Practice Address - Fax:718-667-5161
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY121858208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00272922Medicaid
NY908561Medicare ID - Type Unspecified
NY00272922Medicaid