Provider Demographics
NPI:1194524678
Name:OMIDVARI PSYCHIATRY P.C.
Entity type:Organization
Organization Name:OMIDVARI PSYCHIATRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMADMEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:OMIDVARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-874-9340
Mailing Address - Street 1:73 VAN ETTEN BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1123 BROADWAY STE 1117
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2007
Practice Address - Country:US
Practice Address - Phone:646-874-9340
Practice Address - Fax:646-809-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty