Healthcare Provider Details

I. General information

NPI: 1831022623
Provider Name (Legal Business Name): FARSHAD SHAFIZADEH, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

461 PARK AVE S FL 3
NEW YORK NY
10016-7580
US

IV. Provider business mailing address

461 PARK AVE S FL 3
NEW YORK NY
10016-7580
US

V. Phone/Fax

Practice location:
  • Phone: 212-777-8566
  • Fax: 646-536-8738
Mailing address:
  • Phone: 212-777-8566
  • Fax: 646-536-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. FARSHAD SHAFIZADEH
Title or Position: PRESIDENT
Credential: MD
Phone: 212-777-8566