Provider Demographics
NPI:1942389812
Name:MONDANA YAZDI PA
Entity Type:Organization
Organization Name:MONDANA YAZDI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONDANA
Authorized Official - Middle Name:SEPAHI
Authorized Official - Last Name:YAZDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAP
Authorized Official - Phone:201-891-4777
Mailing Address - Street 1:219 EVERETT AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1904
Mailing Address - Country:US
Mailing Address - Phone:201-891-4777
Mailing Address - Fax:
Practice Address - Street 1:219 EVERETT AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1904
Practice Address - Country:US
Practice Address - Phone:201-891-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06164400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty