Provider Demographics
NPI:1912149675
Name:HADI, MEHVASH (DO)
Entity Type:Individual
Prefix:
First Name:MEHVASH
Middle Name:
Last Name:HADI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3718
Mailing Address - Country:US
Mailing Address - Phone:516-513-0836
Mailing Address - Fax:516-342-1452
Practice Address - Street 1:100 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-3718
Practice Address - Country:US
Practice Address - Phone:516-513-0836
Practice Address - Fax:516-342-1452
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266126208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400084547Medicare PIN