Provider Demographics
NPI:1447812482
Name:RAZAVI, AFSOON (MD)
Entity type:Individual
Prefix:
First Name:AFSOON
Middle Name:
Last Name:RAZAVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E MAIN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3114
Mailing Address - Country:US
Mailing Address - Phone:631-654-3278
Mailing Address - Fax:631-654-1474
Practice Address - Street 1:325 E MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3114
Practice Address - Country:US
Practice Address - Phone:631-654-3278
Practice Address - Fax:631-654-1474
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-30
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine