Provider Demographics
NPI:1255329017
Name:FARHANGIAN, DAVOOD (MD)
Entity Type:Individual
Prefix:
First Name:DAVOOD
Middle Name:
Last Name:FARHANGIAN
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 1:2555 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1248
Mailing Address - Country:US
Mailing Address - Phone:718-445-5352
Mailing Address - Fax:718-762-3933
Practice Address - Street 1:2555 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1248
Practice Address - Country:US
Practice Address - Phone:718-445-5352
Practice Address - Fax:718-762-3933
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112152208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00202704Medicaid
NYB88742Medicare UPIN
NY00202704Medicaid