Individual
JAMAL MAHDAVIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
40 HURLEY AVE SUITE 5, KINGSTON, NY 12401
(845) 338-9488
(845) 338-6774
Mailing address
40 HURLEY AVE SUITE 5, KINGSTON, NY 12401
(845) 338-9488
(845) 338-6774
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
207514-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01770869
—
NY
01
—
CJ9902
RAILROAD MEDICARE
NY
Enumeration date
01/18/2007
Last updated
12/08/2021
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