Miriam Tavakoly

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1664 E 14TH St
Suite 101
Brooklyn, NY 11229-1155

Phone

(718) 998-2350

NPI assigned

May 20, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Corona Medical PCGroup PAC ID 0749421279, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

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.

• Corona Medical PC

  • Internal Medicine Physician
  • Elmhurst, NY
  • NPI 1699026385
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1337472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337472000000",
    "number": "1710247192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650067",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113650067",
            "telephone_number": "917-605-7453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1664 E 14TH ST",
            "address_2": "SUITE 101",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291155",
            "telephone_number": "718-998-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVAKOLY",
        "first_name": "MIRIAM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-20",
        "last_updated": "2012-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hao Yun Taur
• Alicia Tauro
• Emily Krystine Tavag, CPNP-PC
• Khashayar Tavakoli, MD
• Afshin Tavakoly, M.D.
• Samar Tavana
• Alexia Tavar
• Jeffrey Gerard Tavares, MD
• Branny Fausto Tavarez Melendez, FNP
• Carol Tavarez, LMSW

• Physician Assistant in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.