| Doctor Name: | DR. FOROOZAN MOKHTARIAN |
| NPI Number: | 1487822375 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MPH, PHD |
| License Number: | MOKHF1 |
| Business Practice Address: | Suny Incubator 4603 Middle Country Road Suite 12-3 Calverton, NY - 11933 |
| Business Phone Number: | 9175181319 |
| Business Fax Number: | 7186357088 |
| Mailing Address: | Suny Stonybrook 4603 Middle Country Road, Suite 12-3 CALVERTON |
| State: | NY |
| Postal Code: | 11933 |
| Phone Number: | 9175181319 |
| Fax Number: | 7186357088 |
| NPI Enumeration Date: | 02/14/2008 |
| NPI Last Update Date: | 02/14/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 247ZC0005X |
| License Number: | MOKHF1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Pathology |
| Taxonomy Specialization: | Clinical Laboratory Director, Non-physician |
| Taxonomy Definition: | An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments of 1988 for non-physicians (non-MD/DO) as defined in the CFR 42 Part 493.1405. |