Provider Demographics
NPI:1932825643
Name:FIRDAVSI, MOHINUR (PA-C)
Entity Type:Individual
Prefix:
First Name:MOHINUR
Middle Name:
Last Name:FIRDAVSI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 BENSON AVE APT 5A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5031
Mailing Address - Country:US
Mailing Address - Phone:347-988-1145
Mailing Address - Fax:
Practice Address - Street 1:2126 BENSON AVE APT 5A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5031
Practice Address - Country:US
Practice Address - Phone:347-988-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NY029384363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical