Provider Demographics
NPI:1962582676
Name:RAFAELMEHR, PARVIZ (MD)
Entity type:Individual
Prefix:DR
First Name:PARVIZ
Middle Name:
Last Name:RAFAELMEHR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 GRISTMILL LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1836
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9712 63RD DR
Practice Address - Street 2:SUITE 1B
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2243
Practice Address - Country:US
Practice Address - Phone:718-897-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01506858Medicaid
NY01506858Medicaid
NY01405Medicare ID - Type Unspecified