Provider Demographics
NPI:1366448094
Name:LALEHZARIAN, FARSHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FARSHAD
Middle Name:
Last Name:LALEHZARIAN
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 1:1546 LAUREL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-9635
Mailing Address - Country:US
Mailing Address - Phone:516-316-8101
Mailing Address - Fax:
Practice Address - Street 1:1546 LAUREL HOLLOW RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-9635
Practice Address - Country:US
Practice Address - Phone:516-316-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178895207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01465558Medicaid
NYF58436Medicare UPIN
NY84F741Medicare ID - Type UnspecifiedEMPIRE MEDICARE