Basic Information
Provider Information
NPI: 1003014267
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEHRAZIN
FirstName: REZA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
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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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000XMD444707PAN Allopathic & Osteopathic PhysiciansUrology 
208800000X275768-1NYY Allopathic & Osteopathic PhysiciansUrology 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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