Provider Demographics
NPI:1811735822
Name:JACOB GOHARI, MD PLLC
Entity type:Organization
Organization Name:JACOB GOHARI, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GOHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-765-8425
Mailing Address - Street 1:9 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1809
Mailing Address - Country:US
Mailing Address - Phone:917-765-8425
Mailing Address - Fax:
Practice Address - Street 1:9 WOOD RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024-1809
Practice Address - Country:US
Practice Address - Phone:917-765-8425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty