Healthcare Provider Details

I. General information

NPI: 1124912761
Provider Name (Legal Business Name): DR. ARYA FIROOZAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 197TH ST
FRESH MEADOWS NY
11366-1814
US

IV. Provider business mailing address

7321 197TH ST
FRESH MEADOWS NY
11366-1814
US

V. Phone/Fax

Practice location:
  • Phone: 718-678-3985
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number071368
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: