Basic Information
| Provider Information | |||||||||
| NPI: | 1174559926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLYAN | ||||||||
| FirstName: | FARAIDOON | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6902 AUSTIN ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113754250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187936800 | ||||||||
| FaxNumber: | 7182614312 | ||||||||
| Practice Location | |||||||||
| Address1: | 6902 AUSTIN ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113754250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187936800 | ||||||||
| FaxNumber: | 7182614312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 11/07/2017 | ||||||||
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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 | 207RC0000X | 190702 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 01895596 | 05 | NY | MEDICAID |