Provider Demographics
NPI:1912902636
Name:SAFAROV, ALEXANDR L (MD)
Entity type:Individual
Prefix:MR
First Name:ALEXANDR
Middle Name:L
Last Name:SAFAROV
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 1:21 FOX STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4723
Mailing Address - Country:US
Mailing Address - Phone:845-452-9750
Mailing Address - Fax:518-822-8010
Practice Address - Street 1:67 PROSPECT AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2914
Practice Address - Country:US
Practice Address - Phone:845-452-9750
Practice Address - Fax:518-822-8010
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231231-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2464458OtherUNITED HEALTHCARE
NYA400009576Medicare PIN
NY2464458OtherUNITED HEALTHCARE