Provider Demographics
NPI:1700059680
Name:TAVAKOLY, AFSHIN (MD)
Entity type:Individual
Prefix:DR
First Name:AFSHIN
Middle Name:
Last Name:TAVAKOLY
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 1:623 MIDDLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1245
Mailing Address - Country:US
Mailing Address - Phone:917-605-7233
Mailing Address - Fax:
Practice Address - Street 1:1664 E 14TH ST STE 101
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1162
Practice Address - Country:US
Practice Address - Phone:718-998-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247938207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine