Individual
DR. MO TAVAKKOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH, MSC
Contact information
Practice address
140 OLD ORANGEBURG RD, ORANGEBURG, NY 10962-1157
(845) 680-5713
Mailing address
1 HARBOR SQ APT 632, OSSINING, NY 10562-4535
(917) 943-3539
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
287439
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
287439
NYS LICENSE
NY
Enumeration date
06/27/2013
Last updated
12/29/2024
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