Basic Information
| Provider Information | |||||||||
| NPI: | 1003014267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEHRAZIN | ||||||||
| FirstName: | REZA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 GUSTAVE L LEVY PL # 1272 | ||||||||
| Address2: | MOUNT SINAI SCHOOL OF MEDICINE / UROLOGY DEPT | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122414812 | ||||||||
| FaxNumber: | 2129874675 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 GUSTAVE L LEVY PL # 1272 | ||||||||
| Address2: | MOUNT SINAI SCHOOL OF MEDICINE / UROLOGY DEPT | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122414812 | ||||||||
| FaxNumber: | 2129874675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 01/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 275768-1 | NY | Y | Allopathic & Osteopathic Physicians | Urology | 208800000X | MD444707 | PA | N | Allopathic & Osteopathic Physicians | Urology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.