Provider Demographics
NPI:1831990217
Name:FARNAZ FAHIMIRAD
Entity type:Organization
Organization Name:FARNAZ FAHIMIRAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:FARNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHIMIRAD
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CDN, CLC
Authorized Official - Phone:917-794-9175
Mailing Address - Street 1:9809 64TH RD APT 1D
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3413
Mailing Address - Country:US
Mailing Address - Phone:917-794-9175
Mailing Address - Fax:
Practice Address - Street 1:9809 64TH RD APT 1D
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3413
Practice Address - Country:US
Practice Address - Phone:917-794-9175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-21
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty