Provider Demographics
NPI:1801974159
Name:HAIDERY, GHAZANFAR W (MD)
Entity type:Individual
Prefix:
First Name:GHAZANFAR
Middle Name:W
Last Name:HAIDERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26 GEORGE STREET
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577
Mailing Address - Country:US
Mailing Address - Phone:516-676-1500
Mailing Address - Fax:516-676-6063
Practice Address - Street 1:997 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545
Practice Address - Country:US
Practice Address - Phone:516-676-1500
Practice Address - Fax:516-759-5946
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY210618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
179962POtherHP
P1127871OtherOXFORD
179962POtherHP
G72742Medicare UPIN