Provider Demographics
NPI:1518945310
Name:PAHLAVAN, MOHSEN (MD)
Entity Type:Individual
Prefix:
First Name:MOHSEN
Middle Name:
Last Name:PAHLAVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 OLD COUNTRY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-6505
Mailing Address - Country:US
Mailing Address - Phone:516-261-9988
Mailing Address - Fax:516-612-0071
Practice Address - Street 1:1097 OLD COUNTRY RD STE 101
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803
Practice Address - Country:US
Practice Address - Phone:516-261-9988
Practice Address - Fax:516-612-0071
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229485207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02574830Medicaid
I02638Medicare UPIN
NY02574830Medicaid
NY6X9861Medicare PIN