Provider Demographics
NPI:1477544922
Name:FARCON, EDUARDO M (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:M
Last Name:FARCON
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 1:530 1ST AVE
Mailing Address - Street 2:STE 3D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-7018
Mailing Address - Fax:212-263-7011
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-7018
Practice Address - Fax:212-263-7011
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY121472208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00227812Medicaid
NY307431Medicare PIN
B12649Medicare UPIN