Provider Demographics
NPI:1285603746
Name:FOROHAR, FARZAD (MD)
Entity type:Individual
Prefix:MR
First Name:FARZAD
Middle Name:
Last Name:FOROHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ROUTE 111
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3738
Mailing Address - Country:US
Mailing Address - Phone:631-724-5300
Mailing Address - Fax:631-724-5400
Practice Address - Street 1:50 ROUTE 111
Practice Address - Street 2:SUITE 302
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3738
Practice Address - Country:US
Practice Address - Phone:631-724-5300
Practice Address - Fax:631-724-5400
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201902207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G91447Medicare UPIN
57N851Medicare ID - Type Unspecified