Individual
DR. JAN A KHORSANDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD PC
Contact information
Practice address
1874 CLOVE RD, STATEN ISLAND, NY 10304-1637
(718) 273-0212
Mailing address
1874 CLOVE RD, STATEN ISLAND, NY 10304-1637
(718) 273-0212
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
051098L
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02617999
—
NY
Enumeration date
12/02/2005
Last updated
07/08/2007
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