Provider Demographics
NPI:1922076397
Name:BOROJENI, PARVANEH (MD)
Entity Type:Individual
Prefix:
First Name:PARVANEH
Middle Name:
Last Name:BOROJENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WEBSTER AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1361
Mailing Address - Country:US
Mailing Address - Phone:845-483-5852
Mailing Address - Fax:845-483-5413
Practice Address - Street 1:1 WEBSTER AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1361
Practice Address - Country:US
Practice Address - Phone:845-483-5852
Practice Address - Fax:845-483-5413
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15509612080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine