Provider Demographics
NPI:1669447538
Name:HABIBI KHAMENEH, BEHZAD (MD)
Entity Type:Individual
Prefix:
First Name:BEHZAD
Middle Name:
Last Name:HABIBI KHAMENEH
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 1:69 SAND PIT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4004
Mailing Address - Country:US
Mailing Address - Phone:203-748-2551
Mailing Address - Fax:203-790-6375
Practice Address - Street 1:69 SAND PIT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4004
Practice Address - Country:US
Practice Address - Phone:203-748-2551
Practice Address - Fax:203-790-6375
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0420612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI40124Medicare UPIN