Provider Demographics
NPI:1588723993
Name:KOLAHIFAR, JAFAR (MD)
Entity type:Individual
Prefix:
First Name:JAFAR
Middle Name:
Last Name:KOLAHIFAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:222 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:SUITE #219
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2871
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 MIDDLE COUNTRY ROAD
Practice Address - Street 2:SUITE #219
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2871
Practice Address - Country:US
Practice Address - Phone:631-979-9889
Practice Address - Fax:631-979-5317
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2008-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1162212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00681892Medicaid
NY00681892Medicaid
NY70A422Medicare PIN