Provider Demographics
NPI:1700347556
Name:SHARGANI, KOUROSH (DO)
Entity type:Individual
Prefix:
First Name:KOUROSH
Middle Name:
Last Name:SHARGANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1928
Mailing Address - Country:US
Mailing Address - Phone:516-365-1700
Mailing Address - Fax:516-365-7565
Practice Address - Street 1:45 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1928
Practice Address - Country:US
Practice Address - Phone:516-365-1700
Practice Address - Fax:516-365-7565
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY317427207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program