Provider Demographics
NPI:1154631729
Name:HENGAMEH ARDALAN, M.D., P.C.
Entity Type:Organization
Organization Name:HENGAMEH ARDALAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FAELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-650-4604
Mailing Address - Street 1:57-48 256TH STREET
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362
Mailing Address - Country:US
Mailing Address - Phone:347-724-2168
Mailing Address - Fax:516-593-1923
Practice Address - Street 1:94-13 FLATLANDS AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236
Practice Address - Country:US
Practice Address - Phone:718-576-1999
Practice Address - Fax:516-593-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty