Provider Demographics
NPI:1356030415
Name:PEYVANDI, FOROUHIDEH (MD)
Entity type:Individual
Prefix:DR
First Name:FOROUHIDEH
Middle Name:
Last Name:PEYVANDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:FOROUHID
Other - Middle Name:
Other - Last Name:PEYVANDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:269-01 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:718-470-3204
Mailing Address - Fax:
Practice Address - Street 1:269-01 76TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:718-470-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-12-11
Deactivation Date:2023-12-07
Deactivation Code:
Reactivation Date:2023-12-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program