Healthcare Provider Details

I. General information

NPI: 1285668673
Provider Name (Legal Business Name): ELIZABETH WORLEY FARMAN-FARMAIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH WORLEY MD

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S BUILDING 1, ROOM 808
BRONX NY
10461-1138
US

IV. Provider business mailing address

1400 PELHAM PKWY S BUILDING 1, ROOM 808
BRONX NY
10461-1138
US

V. Phone/Fax

Practice location:
  • Phone: 650-714-9493
  • Fax:
Mailing address:
  • Phone: 650-714-9493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC52168
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number210289-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: