Provider Demographics
NPI:1013953975
Name:SHARAFATKHAH, MATIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATIN
Middle Name:
Last Name:SHARAFATKHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1432
Mailing Address - Country:US
Mailing Address - Phone:212-307-1151
Mailing Address - Fax:212-307-0759
Practice Address - Street 1:1655 E 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1101
Practice Address - Country:US
Practice Address - Phone:718-339-3100
Practice Address - Fax:718-339-3905
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206167207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02052775Medicaid
NY02052775Medicaid
NY16B211Medicare ID - Type Unspecified