Basic Information
| Provider Information | |||||||||
| NPI: | 1720345879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLBARI | ||||||||
| FirstName: | SHERVIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 166 E 34TH ST APT 12L | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100164728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109891227 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 OLD COUNTRY RD STE 278 | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115014298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168770977 | ||||||||
| FaxNumber: | 5162946861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2012 | ||||||||
| LastUpdateDate: | 07/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 298752 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.