Provider Demographics
NPI:1790205177
Name:RAHBARAN, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:RAHBARAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CHELSEA PL APT 1J
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3265
Mailing Address - Country:US
Mailing Address - Phone:917-717-0842
Mailing Address - Fax:
Practice Address - Street 1:345 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3904
Practice Address - Country:US
Practice Address - Phone:212-941-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI064230-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist