Provider Demographics
NPI:1255310751
Name:FARHANGI, EDWARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:FARHANGI
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 1:1020A E BOAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1509
Mailing Address - Country:US
Mailing Address - Phone:814-237-8627
Mailing Address - Fax:814-238-0083
Practice Address - Street 1:111 MARYS AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5852
Practice Address - Country:US
Practice Address - Phone:845-339-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2103832085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000496057001OtherBCBS NENY
NY000496057002OtherBCBS NENY
NY2342145OtherAETNA USHC HMO
NY397246OtherMVP
NY45609OtherGHI HMO
NY10034670OtherCDPHP
NY318243OtherMVP
NY3U8551OtherEMPIRE BCBS
NY9601022OtherGHI
NY000496057003OtherBCBS NENY
NY01863565Medicaid
NY2H2411OtherEMPIRE BCBS
NY2341569OtherAETNA USHC HMO
NY4099750OtherGHI PPO
NY7340099OtherAETNA USHC PPO
NY9601022OtherGHI
NY01863565Medicaid