Provider Demographics
NPI:1861679359
Name:VAHIDY, TAQDEES A
Entity Type:Individual
Prefix:MR
First Name:TAQDEES
Middle Name:A
Last Name:VAHIDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PLEASANT PL
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2117
Mailing Address - Country:US
Mailing Address - Phone:631-736-1368
Mailing Address - Fax:
Practice Address - Street 1:822 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2506
Practice Address - Country:US
Practice Address - Phone:631-698-3102
Practice Address - Fax:631-698-0474
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01370149Medicaid