Provider Demographics
NPI:1003014267
Name:MEHRAZIN, REZA (MD)
Entity type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:MEHRAZIN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L LEVY PL # 1272
Mailing Address - Street 2:MOUNT SINAI SCHOOL OF MEDICINE / UROLOGY DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6504
Mailing Address - Country:US
Mailing Address - Phone:212-241-4812
Mailing Address - Fax:212-987-4675
Practice Address - Street 1:1 GUSTAVE L LEVY PL # 1272
Practice Address - Street 2:MOUNT SINAI SCHOOL OF MEDICINE / UROLOGY DEPT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6504
Practice Address - Country:US
Practice Address - Phone:212-241-4812
Practice Address - Fax:212-987-4675
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2015-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY275768-1208800000X
PAMD444707208800000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program