Provider Demographics
NPI:1639791155
Name:AMIR REZA RADJABI MEDICAL PLLC
Entity Type:Organization
Organization Name:AMIR REZA RADJABI MEDICAL PLLC
Other - Org Name:NEW HERITAGE FERTILITY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMIR REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADJABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-444-5444
Mailing Address - Street 1:240 CENTRAL PARK S APT 1P
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1429
Mailing Address - Country:US
Mailing Address - Phone:800-750-8616
Mailing Address - Fax:845-362-8474
Practice Address - Street 1:240 CENTRAL PARK S APT 1P
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1429
Practice Address - Country:US
Practice Address - Phone:212-535-5350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4897536Medicaid