Provider Demographics
NPI:1316118482
Name:DAVID MAHGEREFTEH
Entity type:Organization
Organization Name:DAVID MAHGEREFTEH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHGEREFTEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-997-9633
Mailing Address - Street 1:9909 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4513
Mailing Address - Country:US
Mailing Address - Phone:718-997-9633
Mailing Address - Fax:718-997-0840
Practice Address - Street 1:230 MIDDLE NECK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1113
Practice Address - Country:US
Practice Address - Phone:516-829-2560
Practice Address - Fax:718-997-0840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID MAHGEREFTEH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0956840003Medicare NSC