Provider Demographics
NPI:1760793194
Name:JAMSHIDI, ABOLGHASSEM (PHD)
Entity Type:Individual
Prefix:MR
First Name:ABOLGHASSEM
Middle Name:
Last Name:JAMSHIDI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CARLTON AVE
Mailing Address - Street 2:APT D-47
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3545
Mailing Address - Country:US
Mailing Address - Phone:516-767-8804
Mailing Address - Fax:718-470-8445
Practice Address - Street 1:27005 76TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1402
Practice Address - Country:US
Practice Address - Phone:718-470-7386
Practice Address - Fax:718-470-8445
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000053-1174400000X
NY000029-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist