Provider Demographics
NPI:1528740784
Name:NAKHJAVAN SHAHRAKI, BABAK
Entity type:Individual
Prefix:
First Name:BABAK
Middle Name:
Last Name:NAKHJAVAN SHAHRAKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7558 113TH ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7428
Mailing Address - Country:US
Mailing Address - Phone:347-779-3627
Mailing Address - Fax:
Practice Address - Street 1:6970 GRAND CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3949
Practice Address - Country:US
Practice Address - Phone:460-071-8263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine