Provider Demographics
NPI:1013498450
Name:HOORBOD DELSHADFAR MEDICAL PC
Entity Type:Organization
Organization Name:HOORBOD DELSHADFAR MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DO
Authorized Official - Prefix:DR
Authorized Official - First Name:HOORBOD
Authorized Official - Middle Name:
Authorized Official - Last Name:DELSHADFAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-775-8605
Mailing Address - Street 1:5 GRENWOLDE DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1616
Mailing Address - Country:US
Mailing Address - Phone:516-482-0500
Mailing Address - Fax:
Practice Address - Street 1:287 NORTHERN BLVD STE 108
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4717
Practice Address - Country:US
Practice Address - Phone:516-482-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty