Provider Demographics
NPI:1295728772
Name:SAFAVI, ALI (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SAFAVI
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:PO BOX 9184
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11555-9184
Mailing Address - Country:US
Mailing Address - Phone:212-828-7700
Mailing Address - Fax:212-828-7800
Practice Address - Street 1:75 E 116TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1150
Practice Address - Country:US
Practice Address - Phone:212-828-7700
Practice Address - Fax:212-828-7800
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166814208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01399857Medicaid
NY55H422Medicare PIN
NY01399857Medicaid
A93270Medicare UPIN