Basic Information
| Provider Information | |||||||||
| NPI: | 1316385925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAZAYERI | ||||||||
| FirstName: | AMIR | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2465 MEMPHIS ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191252124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202273551 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3601 A STREET | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154275000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2013 | ||||||||
| LastUpdateDate: | 06/06/2013 | ||||||||
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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 | 208000000X | MT204338 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.