Provider Demographics
NPI:1669476081
Name:FAYYAZI, AMIR H (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:H
Last Name:FAYYAZI
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 1:250 CETRONIA RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9147
Mailing Address - Country:US
Mailing Address - Phone:610-973-6200
Mailing Address - Fax:866-644-0894
Practice Address - Street 1:250 CETRONIA RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9147
Practice Address - Country:US
Practice Address - Phone:610-973-6200
Practice Address - Fax:866-644-0894
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232814207XS0117X, 207X00000X
PAMD073263L207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02567926Medicaid
PA1019835830001Medicaid
NY232814OtherLICENSE
PA0292440001Medicare NSC
PAI12555Medicare UPIN
NYRA2745Medicare PIN
PA1019835830001Medicaid
NYI12555Medicare UPIN