Provider Demographics
NPI:1699392894
Name:FEIZI LIGHVAN, MOHAMMADREZA (NP)
Entity Type:Individual
Prefix:
First Name:MOHAMMADREZA
Middle Name:
Last Name:FEIZI LIGHVAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:
Other - Last Name:FEIZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVENUE PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-1376
Mailing Address - Fax:
Practice Address - Street 1:STRONG MEMORIAL HOSPITAL 601 ELMWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-5645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF431689207T00000X, 363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care