Provider Demographics
NPI:1780693572
Name:MOAREFI, MEHRAN (MD)
Entity type:Individual
Prefix:
First Name:MEHRAN
Middle Name:
Last Name:MOAREFI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MASOUD-REZA
Other - Middle Name:
Other - Last Name:MOAREFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8201 37TH AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7011
Mailing Address - Country:US
Mailing Address - Phone:646-747-8079
Mailing Address - Fax:718-777-1623
Practice Address - Street 1:8201 37TH AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7011
Practice Address - Country:US
Practice Address - Phone:718-899-7878
Practice Address - Fax:718-899-2135
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02610960Medicaid
NY1513P1Medicare PIN
NY02610960Medicaid
G400019584Medicare PIN
NY4989LMMedicare PIN