Provider Demographics
NPI:1144281197
Name:FAKHERI, FARZAD (MD)
Entity type:Individual
Prefix:
First Name:FARZAD
Middle Name:
Last Name:FAKHERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:KINGS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1435
Mailing Address - Country:US
Mailing Address - Phone:718-720-2001
Mailing Address - Fax:718-981-3542
Practice Address - Street 1:11 RALPH PL STE 106
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304
Practice Address - Country:US
Practice Address - Phone:718-720-2001
Practice Address - Fax:718-981-3542
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY191296207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G20059Medicare UPIN