Provider Demographics
NPI:1952572018
Name:DAVID MAHGEREFTEH
Entity Type:Organization
Organization Name:DAVID MAHGEREFTEH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHGEREFTEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-997-9633
Mailing Address - Street 1:9909 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4513
Mailing Address - Country:US
Mailing Address - Phone:718-997-9633
Mailing Address - Fax:718-997-0840
Practice Address - Street 1:4405 16TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1013
Practice Address - Country:US
Practice Address - Phone:718-633-8662
Practice Address - Fax:718-997-0840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID MAHGEREFTEH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-17
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0956840002Medicare NSC