Provider Demographics
NPI:1407994916
Name:SAFRAN, MICHAEL L (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:SAFRAN
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 1:501 HURLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12443
Mailing Address - Country:US
Mailing Address - Phone:845-339-4667
Mailing Address - Fax:845-339-4668
Practice Address - Street 1:501 HURLEY AVENUE
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12443
Practice Address - Country:US
Practice Address - Phone:845-339-4667
Practice Address - Fax:845-339-4668
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-10-12
Deactivation Date:2018-10-01
Deactivation Code:
Reactivation Date:2018-10-11
Provider Licenses
StateLicense IDTaxonomies
NY153063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10031945OtherCDPHP
3014OtherGHI HMO
NY00898595Medicaid
087224OtherMVP
B14891Medicare UPIN
B14891Medicare UPIN