Basic Information
| Provider Information | |||||||||
| NPI: | 1174814933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANSARI | ||||||||
| FirstName: | FARRUKH | ||||||||
| MiddleName: | AZIZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 EVERETT RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122051447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1854892663 | ||||||||
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| Practice Location | |||||||||
| Address1: | 121 EVERETT RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122051447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184539088 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2011 | ||||||||
| LastUpdateDate: | 12/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 269588 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208VP0000X | 269588 | NY | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | J400215424 | 01 | NY | MEDICARE PTAN | OTHER |