Provider Demographics
NPI:1265609911
Name:TAVAZOIE, SOHAIL FAKHR (MD)
Entity type:Individual
Prefix:DR
First Name:SOHAIL
Middle Name:FAKHR
Last Name:TAVAZOIE
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 1:1233 YORK AVE
Mailing Address - Street 2:APT. 9I
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6306
Mailing Address - Country:US
Mailing Address - Phone:617-721-4151
Mailing Address - Fax:
Practice Address - Street 1:415 E 68TH ST
Practice Address - Street 2:ROOM 1345
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6305
Practice Address - Country:US
Practice Address - Phone:888-646-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236409281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital