Provider Demographics
NPI:1275396582
Name:HYDERI, FARDIN AKBAR
Entity Type:Individual
Prefix:
First Name:FARDIN
Middle Name:AKBAR
Last Name:HYDERI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14021 173RD ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4625
Mailing Address - Country:US
Mailing Address - Phone:646-886-5971
Mailing Address - Fax:
Practice Address - Street 1:70 E SUNRISE HWY STE 605
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1233
Practice Address - Country:US
Practice Address - Phone:718-295-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP125309261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation