Provider Demographics
NPI:1427070358
Name:NOORANI, MEHRDAD (DMD)
Entity type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:NOORANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 63RD ST
Mailing Address - Street 2:SUITE 816
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7466
Mailing Address - Country:US
Mailing Address - Phone:212-682-0866
Mailing Address - Fax:
Practice Address - Street 1:271 MADISON AVE
Practice Address - Street 2:SUITE 801
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1001
Practice Address - Country:US
Practice Address - Phone:212-682-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0410171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01070319Medicaid