Provider Demographics
NPI:1467607846
Name:ALEXANDER FARCA MD
Entity Type:Organization
Organization Name:ALEXANDER FARCA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:FARCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-751-1512
Mailing Address - Street 1:21 34 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4533
Mailing Address - Country:US
Mailing Address - Phone:917-751-1512
Mailing Address - Fax:
Practice Address - Street 1:21 34 BROADWAY
Practice Address - Street 2:1 FL
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4533
Practice Address - Country:US
Practice Address - Phone:917-751-1512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107267261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00188725Medicaid