Provider Demographics
NPI:1962462739
Name:FARD, ALI K (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:K
Last Name:FARD
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 1:468 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2175
Mailing Address - Country:US
Mailing Address - Phone:212-686-2220
Mailing Address - Fax:212-686-2221
Practice Address - Street 1:468 W 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2175
Practice Address - Country:US
Practice Address - Phone:212-686-2220
Practice Address - Fax:212-686-2221
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216798207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG71323Medicare UPIN
NY414P01Medicare ID - Type Unspecified