Basic Information
| Provider Information | |||||||||
| NPI: | 1003139627 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELIJANI | ||||||||
| FirstName: | PARHAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S., LAC. | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 00423-1 | NY | Y | Other Service Providers | Acupuncturist |
No ID Information.