Basic Information
| Provider Information | |||||||||
| NPI: | 1639261159 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANSARI | ||||||||
| FirstName: | IRADJ | ||||||||
| MiddleName: | - | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16450 GULF BLVD | ||||||||
| Address2: | APT 263 | ||||||||
| City: | NORTH REDINGTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337081575 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 16450 GULF BLVD | ||||||||
| Address2: | APT 263 | ||||||||
| City: | NORTH REDINGTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337081575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273986661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 282N00000X | 128460 | NY | Y | Hospitals | General Acute Care Hospital |
No ID Information.