1477173995 NPI number — DR. ATAOLLAH RAJABNEJAD MD

Table of content: DR. ATAOLLAH RAJABNEJAD MD (NPI 1477173995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477173995 NPI number — DR. ATAOLLAH RAJABNEJAD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAJABNEJAD
Provider First Name:
ATAOLLAH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477173995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
670 STONELEIGH AVENUE, BLDG 664
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
CARMEL HAMLET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-790-1321
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 STONELEIGH AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10512-3997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-790-1321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  79283 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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