Provider Demographics
NPI:1174617674
Name:MONAHEMI, POURRAT (MD)
Entity type:Individual
Prefix:DR
First Name:POURRAT
Middle Name:
Last Name:MONAHEMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3795 E. TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465
Mailing Address - Country:US
Mailing Address - Phone:718-828-5564
Mailing Address - Fax:718-829-7984
Practice Address - Street 1:3795 E. TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465
Practice Address - Country:US
Practice Address - Phone:718-828-5564
Practice Address - Fax:718-829-7984
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163517207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00907511Medicaid
NY53D682Medicare ID - Type Unspecified
NY00907511Medicaid