Provider Demographics
NPI:1891762555
Name:ASHTYANI, FARIBORZ (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIBORZ
Middle Name:
Last Name:ASHTYANI
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 1:170 PROSPECT AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1820
Mailing Address - Country:US
Mailing Address - Phone:201-996-0232
Mailing Address - Fax:201-996-0095
Practice Address - Street 1:170 PROSPECT AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1820
Practice Address - Country:US
Practice Address - Phone:201-996-0232
Practice Address - Fax:201-996-0095
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05271800207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
612780USMMedicare ID - Type Unspecified
NJE54440Medicare UPIN