Provider Demographics
NPI:1891313151
Name:9301 HEALTH MEDICAL CORNER PC
Entity type:Organization
Organization Name:9301 HEALTH MEDICAL CORNER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHKOOHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-334-0001
Mailing Address - Street 1:9301 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7943
Mailing Address - Country:US
Mailing Address - Phone:718-334-0001
Mailing Address - Fax:718-334-0093
Practice Address - Street 1:9301 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7943
Practice Address - Country:US
Practice Address - Phone:718-334-0001
Practice Address - Fax:718-334-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty