Healthcare Provider Details

I. General information

NPI: 1114174513
Provider Name (Legal Business Name): FARZIN RAHMANOU D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SAINT ANDREWS LN
GLEN COVE NY
11542-2263
US

IV. Provider business mailing address

101 SAINT ANDREWS LN
GLEN COVE NY
11542-2263
US

V. Phone/Fax

Practice location:
  • Phone: 516-674-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number257209
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number257209
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number257209
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: