Provider Demographics
NPI:1881799906
Name:FARSHAD SHAFIZADEH, M.D., P.C.
Entity type:Organization
Organization Name:FARSHAD SHAFIZADEH, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-777-8566
Mailing Address - Street 1:461 PARK AVE S
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6822
Mailing Address - Country:US
Mailing Address - Phone:212-777-8566
Mailing Address - Fax:646-536-8738
Practice Address - Street 1:461 PARK AVE S
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6822
Practice Address - Country:US
Practice Address - Phone:212-777-8566
Practice Address - Fax:646-536-8738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
214924208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02190334Medicaid
NYH37635Medicare UPIN
NYWAW111Medicare ID - Type Unspecified