Provider Demographics
NPI:1871304154
Name:DR AMIRIFELI NOUVELLE AVENUE PLLC
Entity type:Organization
Organization Name:DR AMIRIFELI NOUVELLE AVENUE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRIFELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-784-0824
Mailing Address - Street 1:604 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:431 POND ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3402
Practice Address - Country:US
Practice Address - Phone:617-784-0824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty