Provider Demographics
NPI:1689687857
Name:KOLEINI, JAHANGIR (MD)
Entity Type:Individual
Prefix:
First Name:JAHANGIR
Middle Name:
Last Name:KOLEINI
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 1:2339 UNIUN ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1447
Mailing Address - Country:US
Mailing Address - Phone:716-668-8226
Mailing Address - Fax:716-668-4756
Practice Address - Street 1:2339 UNIUN ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1447
Practice Address - Country:US
Practice Address - Phone:716-668-8226
Practice Address - Fax:716-668-4756
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167700208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01013670Medicaid
NY01013670Medicaid
NY1355BMedicare PIN