Individual provider Active NPI

Mahyar Eidgah, M.D.

  • Family Medicine Physician
  • New York, NY
National Provider Identifier
1710023601
Registry record updated Dec 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
232944 Issued in NY
Practice address
310 E 14TH St
New York, NY 10003-4201
Phone
(212) 979-4204
Fax
(212) 979-4415
NPI assigned
Jan 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 232944 NY Primary

Addresses

Primary practice location

310 E 14TH St
New York, NY 10003-4201

Mailing address

310 E 14TH St
New York, NY 10003-4201
Phone (212) 979-4204

Other identifiers 1

IdentifierTypeStateIssuer
02599177MedicaidNY

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
I20041206000999 NY Practitioner - Family Practice 5294791836 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

111 3Rd Ave
New York, NY 10003-5518
Phone (646) 687-5678

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
232944NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Nyc Primary Medical Care PC Family Medicine CurrentSince Mar 11, 2017 Accepting new patients

Locations

111 3rd Ave
New York, NY 10003
Phone (646) 687-5678

310 E 14th St
New York, NY 10003
Phone (212) 979-4000

310 E 14th St
#L
New York, NY 10003
Phone (212) 979-4204

Organizations & group practices 1

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": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198108800000",
    "number": "1710023601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 E 14TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100034201",
            "telephone_number": "212-979-4204",
            "fax_number": "212-979-4415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 E 14TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100034201",
            "telephone_number": "212-979-4204",
            "fax_number": "212-979-4415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EIDGAH",
        "first_name": "MAHYAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "232944",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02599177",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.