Provider Demographics
NPI:1366079063
Name:RAHIMI, MONA (DO)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:RAHIMI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:RAHIMI-TAREE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4422 THIRD AVENUE
Mailing Address - Street 2:BRAKER BUILDING, 4TH FLOOR ROOM 405
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4422 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2545
Practice Address - Country:US
Practice Address - Phone:718-960-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY330057207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program