Provider Demographics
NPI:1750300950
Name:ILKHANIZADEH, RAHMAN (MD)
Entity type:Individual
Prefix:MR
First Name:RAHMAN
Middle Name:
Last Name:ILKHANIZADEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAHMAN
Other - Middle Name:
Other - Last Name:ILKHANIZADEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:180 OLD WESTBURY RD
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1100
Mailing Address - Country:US
Mailing Address - Phone:718-768-3560
Mailing Address - Fax:212-500-3328
Practice Address - Street 1:849 57TH STREET
Practice Address - Street 2:STE 801
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3797
Practice Address - Country:US
Practice Address - Phone:718-768-3560
Practice Address - Fax:212-500-3328
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146711208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00775553Medicaid
NY92A721Medicare PIN
NY00775553Medicaid