Provider Demographics
NPI:1992843171
Name:JARRAHY, PAYMAN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAYMAN
Middle Name:PAUL
Last Name:JARRAHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9411 59TH AVE
Mailing Address - Street 2:SUITE A-10
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5158
Mailing Address - Country:US
Mailing Address - Phone:718-393-0300
Mailing Address - Fax:718-393-3033
Practice Address - Street 1:7315 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1144
Practice Address - Country:US
Practice Address - Phone:718-424-2788
Practice Address - Fax:718-424-3513
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195694207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01723688Medicaid
NY01723688Medicaid
NYG400012758Medicare PIN
NY0105HBMedicare ID - Type Unspecified