MEDICARE: ALISAN B GOLDFARB M.D. P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	133064	NY

General Provider Information

NPI Number	:	1215261029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALISAN B GOLDFARB M.D. P.C.

Provider Business Mailing Address
First Line	:	1185 PARK AVE
Second Line	:	#1A
City	:	NEW YORK
State	:	NY
Zip	:	10128-1308
Country	:	US
Telephone Number	:	212-987-5000
Fax Number	:	212-987-2981

Provider Business Practice Location Address
First Line	:	1185 PARK AVE
Second Line	:	#1A
City	:	NEW YORK
State	:	NY
Zip	:	10128-1308
Country	:	US
Telephone Number	:	212-987-5000
Fax Number	:	212-987-2981

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALISAN BETH GOLDFARB
Credential	:	M.D.
Telephone Number	:	212-987-5000

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	09/25/2009

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