Provider Demographics
NPI:1841588779
Name:NOOSHIN ZOLFAGHARI D.P.M., P.A.
Entity Type:Organization
Organization Name:NOOSHIN ZOLFAGHARI D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:NOOSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOLFAGHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:786-942-1283
Mailing Address - Street 1:14730 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6107
Mailing Address - Country:US
Mailing Address - Phone:786-942-1283
Mailing Address - Fax:
Practice Address - Street 1:2699 STIRLING RD
Practice Address - Street 2:SUITE A
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6517
Practice Address - Country:US
Practice Address - Phone:954-278-3890
Practice Address - Fax:954-251-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3442213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFS076AMedicare PIN