Provider Demographics
NPI:1295120202
Name:MAHMOUDI, SEYED MORTEZA (MD)
Entity type:Individual
Prefix:DR
First Name:SEYED MORTEZA
Middle Name:
Last Name:MAHMOUDI
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 1:381 ROCKAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212
Mailing Address - Country:US
Mailing Address - Phone:917-297-8603
Mailing Address - Fax:701-780-4477
Practice Address - Street 1:381 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:917-297-8603
Practice Address - Fax:701-780-4477
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25M10908100208000000X
NDPT15121208000000X
NY316384208000000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics