Provider Demographics
NPI:1124024336
Name:SHAHKOOHI, FARID (MD)
Entity Type:Individual
Prefix:DR
First Name:FARID
Middle Name:
Last Name:SHAHKOOHI
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 1:371 MERRICK RD
Mailing Address - Street 2:STE 302
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5301
Mailing Address - Country:US
Mailing Address - Phone:516-678-5555
Mailing Address - Fax:516-678-9128
Practice Address - Street 1:371 MERRICK RD
Practice Address - Street 2:STE 302
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5301
Practice Address - Country:US
Practice Address - Phone:516-678-5555
Practice Address - Fax:516-678-9128
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G73790Medicare UPIN
NY40C651Medicare PIN