Provider Demographics
NPI:1851540488
Name:R MOSTAFAVI MD OPHTHAMOLOGIST PC
Entity Type:Organization
Organization Name:R MOSTAFAVI MD OPHTHAMOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTAFAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-809-6679
Mailing Address - Street 1:3860 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6720
Mailing Address - Country:US
Mailing Address - Phone:718-697-0131
Mailing Address - Fax:718-697-0231
Practice Address - Street 1:3860 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6720
Practice Address - Country:US
Practice Address - Phone:718-697-0131
Practice Address - Fax:718-697-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000469Medicare PIN