Provider Demographics
NPI:1336344241
Name:JOHARI, FATIMA JEBRAEILI
Entity Type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:JEBRAEILI
Last Name:JOHARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FATEMEH
Other - Middle Name:
Other - Last Name:JEBRAEILI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:462 1ST AVE
Mailing Address - Street 2:A418
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-562-4038
Mailing Address - Fax:212-562-5166
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:A418
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-562-4038
Practice Address - Fax:212-562-5166
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260792207RI0200X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist