Provider Demographics
NPI:1386709665
Name:FARAHANI, GHOLAMALI (MD)
Entity type:Individual
Prefix:
First Name:GHOLAMALI
Middle Name:
Last Name:FARAHANI
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 1:935 NORTHERN BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-829-2525
Mailing Address - Fax:516-829-5326
Practice Address - Street 1:935 NORTHERN BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-829-2525
Practice Address - Fax:516-829-5326
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115087207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B77766Medicare UPIN
565481Medicare ID - Type Unspecified