Healthcare Provider Details

I. General information

NPI: 1154631729
Provider Name (Legal Business Name): HENGAMEH ARDALAN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-13 FLATLANDS AVENUE
BROOKLYN NY
11236
US

IV. Provider business mailing address

57-48 256TH STREET SECOND FLOOR
LITTLE NECK NY
11362
US

V. Phone/Fax

Practice location:
  • Phone: 718-576-1999
  • Fax: 516-593-1923
Mailing address:
  • Phone: 347-724-2168
  • Fax: 516-593-1923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHAELA S FAELLA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 516-650-4604