Provider Demographics
NPI:1679096317
Name:JAVIDI, HAMID (MD)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:
Last Name:JAVIDI
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 1:11 WHITES LANE
Mailing Address - Street 2:
Mailing Address - City:AQUEBOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11931
Mailing Address - Country:US
Mailing Address - Phone:631-722-5506
Mailing Address - Fax:
Practice Address - Street 1:11 WHITES LANE
Practice Address - Street 2:
Practice Address - City:AQUEBOGUE
Practice Address - State:NY
Practice Address - Zip Code:11931
Practice Address - Country:US
Practice Address - Phone:631-722-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136191207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology