Provider Demographics
NPI:1093845547
Name:SAFAJOU, CHISTA (MD)
Entity Type:Individual
Prefix:
First Name:CHISTA
Middle Name:
Last Name:SAFAJOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 W CEDAR ST STE 1
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1300
Mailing Address - Country:US
Mailing Address - Phone:845-433-0101
Mailing Address - Fax:845-433-0104
Practice Address - Street 1:68 W CEDAR ST STE 1
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1300
Practice Address - Country:US
Practice Address - Phone:845-433-0101
Practice Address - Fax:845-433-0104
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240008207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology