Provider Demographics
NPI:1215000914
Name:SHIRAZI, FARHAD H (MD)
Entity Type:Individual
Prefix:
First Name:FARHAD
Middle Name:H
Last Name:SHIRAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOSHE
Other - Middle Name:H
Other - Last Name:SHIRAZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:700 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:516-433-4828
Mailing Address - Fax:516-433-1895
Practice Address - Street 1:700 OLD COUNTRY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803
Practice Address - Country:US
Practice Address - Phone:516-433-4828
Practice Address - Fax:516-433-1895
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01837278Medicaid
G34974Medicare UPIN
NY15N441Medicare PIN