Provider Demographics
NPI:1578524914
Name:AZFAR, ADELINA HENRIQUES (DPM)
Entity Type:Individual
Prefix:DR
First Name:ADELINA
Middle Name:HENRIQUES
Last Name:AZFAR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 PRE EMPTION RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1334
Mailing Address - Country:US
Mailing Address - Phone:315-789-8132
Mailing Address - Fax:315-789-8136
Practice Address - Street 1:650 PRE EMPTION RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1334
Practice Address - Country:US
Practice Address - Phone:315-789-8132
Practice Address - Fax:315-789-8136
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3429213E00000X
PASC-004586-L213E00000X
NY006291213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03083805Medicaid