Healthcare Provider Details

I. General information

NPI: 1275396582
Provider Name (Legal Business Name): FARDIN AKBAR HYDERI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E SUNRISE HWY STE 605
VALLEY STREAM NY
11581-1233
US

IV. Provider business mailing address

14021 173RD ST
JAMAICA NY
11434-4625
US

V. Phone/Fax

Practice location:
  • Phone: 718-295-6000
  • Fax:
Mailing address:
  • Phone: 646-886-5971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberP125309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: