Provider Demographics
NPI:1760880470
Name:RAHIMI, ROYA (PA-C, CNMT)
Entity Type:Individual
Prefix:
First Name:ROYA
Middle Name:
Last Name:RAHIMI
Suffix:
Gender:F
Credentials:PA-C, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 KRAKOW ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1407
Mailing Address - Country:US
Mailing Address - Phone:631-383-1157
Mailing Address - Fax:
Practice Address - Street 1:784 FRANKLIN AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1306
Practice Address - Country:US
Practice Address - Phone:201-560-0711
Practice Address - Fax:201-560-0712
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00352500363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical