Basic Information
Provider Information
NPI: 1003139627
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DELIJANI
FirstName: PARHAM
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: M.S., LAC.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 124 W 36TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100186915
CountryCode: US
TelephoneNumber: 2125632242
FaxNumber: 2125630220
Practice Location
Address1: 350 NORTHERN BLVD
Address2:  
City: GREAT NECK
State: NY
PostalCode: 110214809
CountryCode: US
TelephoneNumber: 2125632242
FaxNumber: 2125630220
Other Information
ProviderEnumerationDate: 03/10/2010
LastUpdateDate: 03/10/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171100000X00423-1NYY Other Service ProvidersAcupuncturist 

No ID Information.


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