Provider Demographics
NPI:1336272384
Name:JAVID YADEGAR MD PLLC
Entity Type:Organization
Organization Name:JAVID YADEGAR MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:YADEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-222-8777
Mailing Address - Street 1:856 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-1402
Mailing Address - Country:US
Mailing Address - Phone:718-222-8777
Mailing Address - Fax:718-222-8958
Practice Address - Street 1:856 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-1402
Practice Address - Country:US
Practice Address - Phone:718-222-8777
Practice Address - Fax:718-222-8958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEJ571Medicare PIN