Provider Demographics
NPI:1003911132
Name:SHAFIZADEH, FARSHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FARSHAD
Middle Name:
Last Name:SHAFIZADEH
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 1:461 PARK AVE S
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6822
Mailing Address - Country:US
Mailing Address - Phone:212-777-8566
Mailing Address - Fax:646-536-8738
Practice Address - Street 1:461 PARK AVE S
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6822
Practice Address - Country:US
Practice Address - Phone:212-777-8566
Practice Address - Fax:646-536-8738
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214924207ZP0102X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02190334Medicaid
NY3S2912Medicare ID - Type Unspecified
NY02190334Medicaid