Provider Demographics
NPI:1598542276
Name:MAHTAB MOTIEIAN MD PC
Entity Type:Organization
Organization Name:MAHTAB MOTIEIAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MAHTAB
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTIEIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-955-6577
Mailing Address - Street 1:114 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:114 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2220
Practice Address - Country:US
Practice Address - Phone:904-955-6577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty