Provider Demographics
NPI:1174572127
Name:MAHGEREFTEH, DAVID (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MAHGEREFTEH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4513
Mailing Address - Country:US
Mailing Address - Phone:718-997-9633
Mailing Address - Fax:
Practice Address - Street 1:9909 67TH AVE
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4513
Practice Address - Country:US
Practice Address - Phone:718-997-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004574213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01175135Medicaid
NY0956840004Medicare NSC
NY69743CMedicare ID - Type Unspecified
NYP50942Medicare PIN
NYT97967Medicare UPIN
NY0956840002Medicare NSC
NY0956840003Medicare NSC