Kamyar David Tavakoli Physician Pllc | |
19115 Hillside Ave Hollis NY 11423-1941 | |
(718) 217-5200 | |
Not Available |
Full Name | Kamyar David Tavakoli Physician Pllc |
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Speciality | Internal Medicine |
Location | 19115 Hillside Ave, Hollis, New York |
Authorized Official Name and Position | Daniel Tavakoli (BOOKKEEPER) |
Authorized Official Contact | 7182175200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Kamyar David Tavakoli Physician Pllc 19115 Hillside Ave Hollis NY 11423-1941 Ph: () - | Kamyar David Tavakoli Physician Pllc 19115 Hillside Ave Hollis NY 11423-1941 Ph: (718) 217-5200 |
NPI Number | 1396991774 |
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Provider Enumeration Date | 08/17/2008 |
Last Update Date | 08/17/2008 |
Medicare PECOS PAC ID | 0547444572 |
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Medicare Enrollment ID | O20110415000006 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396991774 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 190615 (New York) | Primary |
Provider Name | Kamyar David Tavakoli |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1528148475 PECOS PAC ID: 1456535483 Enrollment ID: I20110415000129 |
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