Healthcare Provider Details

I. General information

NPI: 1316308406
Provider Name (Legal Business Name): INTERMED MEDICAL NY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 NOSTRAND AVE STE 600
BROOKLYN NY
11210-3948
US

IV. Provider business mailing address

236 BROADWAY SUITE 211
BROOKLYN NY
11211-8414
US

V. Phone/Fax

Practice location:
  • Phone: 718-633-2455
  • Fax:
Mailing address:
  • Phone: 718-633-2455
  • Fax: 718-633-2466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number251936
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: FARZAD HAGHIGHI
Title or Position: MD
Credential: MD
Phone: 929-289-0597