Provider Demographics
NPI:1902840119
Name:HANNANIAN, FARSHAD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:FARSHAD
Middle Name:DAVID
Last Name:HANNANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 NORTHERN BLVD
Mailing Address - Street 2:STE 18
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4802
Mailing Address - Country:US
Mailing Address - Phone:516-773-3048
Mailing Address - Fax:516-304-5011
Practice Address - Street 1:475 NORTHERN BLVD
Practice Address - Street 2:STE 18
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4802
Practice Address - Country:US
Practice Address - Phone:516-773-3048
Practice Address - Fax:516-304-5011
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213283-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01986709Medicaid
NY428N11Medicare UPIN
NYH00620Medicare UPIN