Individual
FOROUGH B MOKHTARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5 SQUIRETOWN ROAD, SOUTH HAMPTON PEDIATRIC, SOUTHAMPTON, NY 11946
(631) 728-5300
(631) 728-5360
Mailing address
45 RESEARCH WAY, STONY BROOK CHILDREN'S SERVICES, UFPC, EAST SETAUKET, NY 11733
(631) 675-2125
(631) 675-2624
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
221651
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02290628
—
NY
Enumeration date
08/05/2006
Last updated
11/02/2015
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