Provider Demographics
NPI:1104051713
Name:IMRAN WAHEDNA M.D P.C
Entity type:Organization
Organization Name:IMRAN WAHEDNA M.D P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHEDNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-623-6076
Mailing Address - Street 1:4 HARTON CT
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-5923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 HARTON CT
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-5923
Practice Address - Country:US
Practice Address - Phone:631-623-6076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty