Provider Demographics
NPI:1619189735
Name:GOLDFARB, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:GOLDFARB
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 1:1575 HILLSIDE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2521
Mailing Address - Country:US
Mailing Address - Phone:516-358-0088
Mailing Address - Fax:516-358-3672
Practice Address - Street 1:1575 HILLSIDE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2521
Practice Address - Country:US
Practice Address - Phone:516-358-0088
Practice Address - Fax:516-358-3672
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2013-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158385207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17E111Medicare ID - Type Unspecified
NYA60941Medicare UPIN