Healthcare Provider Details

I. General information

NPI: 1801719117
Provider Name (Legal Business Name): ALEXANDR SAFAROV MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 GLEN POND DR STE 4
RED HOOK NY
12571-1824
US

IV. Provider business mailing address

9 QUAIL RIDGE RD
HYDE PARK NY
12538-2931
US

V. Phone/Fax

Practice location:
  • Phone: 917-443-7626
  • Fax:
Mailing address:
  • Phone: 917-443-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDR SAFAROV
Title or Position: PRESIDENT
Credential:
Phone: 917-443-9940