Provider Demographics
NPI:1487548889
Name:MORTEZAEI FAR, SEPIDEH
Entity type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:MORTEZAEI FAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33-57 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2174
Mailing Address - Country:US
Mailing Address - Phone:607-762-2990
Mailing Address - Fax:607-762-2639
Practice Address - Street 1:1042 MITCHELL AVE # 42
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1678
Practice Address - Country:US
Practice Address - Phone:607-762-2990
Practice Address - Fax:607-762-2639
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program