Healthcare Provider Details

I. General information

NPI: 1174593685
Provider Name (Legal Business Name): FARHAD HAERI PT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 PARK AVE SUITE #200-12
HUNTINGTON NY
11743
US

IV. Provider business mailing address

1035 WESTMINSTER AVE
DIX HILLS NY
11746
US

V. Phone/Fax

Practice location:
  • Phone: 631-385-0066
  • Fax: 631-385-0770
Mailing address:
  • Phone: 631-385-0066
  • Fax: 631-385-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0155911
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: