Provider Demographics
NPI:1720345879
Name:GOLBARI, SHERVIN (MD)
Entity Type:Individual
Prefix:
First Name:SHERVIN
Middle Name:
Last Name:GOLBARI
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 1:166 E 34TH ST APT 12L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4728
Mailing Address - Country:US
Mailing Address - Phone:310-989-1227
Mailing Address - Fax:
Practice Address - Street 1:200 OLD COUNTRY RD STE 278
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4298
Practice Address - Country:US
Practice Address - Phone:516-877-0977
Practice Address - Fax:516-294-6861
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298752207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease