Provider Demographics
NPI:1174559926
Name:GOLYAN, FARAIDOON DANIEL (DO)
Entity type:Individual
Prefix:DR
First Name:FARAIDOON
Middle Name:DANIEL
Last Name:GOLYAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6902 AUSTIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4250
Mailing Address - Country:US
Mailing Address - Phone:718-793-6800
Mailing Address - Fax:718-261-4312
Practice Address - Street 1:6902 AUSTIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4250
Practice Address - Country:US
Practice Address - Phone:718-793-6800
Practice Address - Fax:718-261-4312
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190702207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01895596Medicaid
NY01895596Medicaid
NY02973Medicare PIN