Provider Demographics
NPI:1497824205
Name:GOLDFARB, ALISAN BETH (MD)
Entity Type:Individual
Prefix:
First Name:ALISAN
Middle Name:BETH
Last Name:GOLDFARB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 PARK AVENUE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1308
Mailing Address - Country:US
Mailing Address - Phone:212-987-5000
Mailing Address - Fax:212-987-2981
Practice Address - Street 1:1185 PARK AVENUE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1308
Practice Address - Country:US
Practice Address - Phone:212-987-5000
Practice Address - Fax:212-987-2981
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133064208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
27A101Medicare ID - Type Unspecified
C07547Medicare UPIN