Provider Demographics
NPI:1245591858
Name:MICHAEL AFSHARI MD, PC
Entity Type:Organization
Organization Name:MICHAEL AFSHARI MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AFSHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:718-740-0800
Mailing Address - Street 1:21604 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3525
Mailing Address - Country:US
Mailing Address - Phone:718-740-0800
Mailing Address - Fax:718-701-1150
Practice Address - Street 1:21604 UNION TPKE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-3525
Practice Address - Country:US
Practice Address - Phone:718-740-0800
Practice Address - Fax:718-701-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125622207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00234946Medicaid
NY92068AOtherMEDICARE
NYE70806Medicare UPIN