Provider Demographics
NPI:1821298829
Name:MAMA, KATAYUN KAYOMARZ
Entity Type:Individual
Prefix:MRS
First Name:KATAYUN
Middle Name:KAYOMARZ
Last Name:MAMA
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 1:38 ALFRED LANE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804
Mailing Address - Country:US
Mailing Address - Phone:914-235-2848
Mailing Address - Fax:
Practice Address - Street 1:16 GUION PLACE
Practice Address - Street 2:SOUND SHORE MEDICAL CENTER
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-632-5000
Practice Address - Fax:914-632-9662
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142230207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01385313Medicaid
NYE17209060Medicare UPIN
NY20F551Medicare PIN