Provider Demographics
NPI:1104055748
Name:GOHARI, NEGIN (DO)
Entity type:Individual
Prefix:
First Name:NEGIN
Middle Name:
Last Name:GOHARI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1211
Mailing Address - Country:US
Mailing Address - Phone:917-715-1003
Mailing Address - Fax:
Practice Address - Street 1:4 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1211
Practice Address - Country:US
Practice Address - Phone:917-715-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259623208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation