Individual provider Active NPI

Reza Taghavi Ardakany, M.D

  • Psychiatry Physician
  • New York, NY
National Provider Identifier
1104085356
Registry record updated Jun 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
263959 Issued in NY
Practice address
315 E 65TH St
Apartment 6a
New York, NY 10065-6862
Phone
(646) 703-4290
NPI assigned
Jun 3, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 263959 NY Primary

Addresses

Primary practice location

315 E 65TH St
Apartment 6a
New York, NY 10065-6862

Mailing address

315 E 65TH St
Apartment 6a
New York, NY 10065-6862
Phone (646) 703-4290

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130829000041 NY Practitioner - Psychiatry 3678716214 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
263959NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bronxcare Health System CurrentSince Nov 11, 2012 Accepting new patients
Bronxcare Health System Psychiatry CurrentSince Nov 11, 2012 Accepting new patients
Samaritan Daytop Village, Inc. CurrentSince Feb 13, 2024 Accepting new patients
Samaritan Daytop Village, Inc. CurrentSince Feb 13, 2024 Accepting new patients

Locations

250 Grand Concourse
Bronx, NY 10451
Phone (718) 292-2240

1276 Fulton Ave
Rm 208
Bronx, NY 10456
Phone (718) 901-8918

1650 Grand Concourse
Bronx, NY 10457
Phone (718) 294-7104

13802 Queens Blvd
Jamaica, NY 11435
Phone (718) 298-5100

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340841600000",
    "number": "1104085356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 E 65TH ST",
            "address_2": "APARTMENT 6A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100656862",
            "telephone_number": "646-703-4290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 E 65TH ST",
            "address_2": "APARTMENT 6A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100656862",
            "telephone_number": "646-703-4290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAGHAVI ARDAKANY",
        "first_name": "REZA",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-03",
        "last_updated": "2012-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "263959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.