Provider Demographics
NPI:1043390107
Name:JOHN K ZAFARANLOO PHYSICIAN PC
Entity Type:Organization
Organization Name:JOHN K ZAFARANLOO PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZAFARANLOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-733-4728
Mailing Address - Street 1:235 DONGAN HILL AVENUE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-351-7650
Mailing Address - Fax:718-351-7615
Practice Address - Street 1:235 DONGAN HILL AVENUE
Practice Address - Street 2:SUITE 2A
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-351-7650
Practice Address - Fax:718-351-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWANX01Medicare PIN