Basic Information
Provider Information
NPI: 1659379626
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABDO
FirstName: FARID
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 244 WESTCHESTER AVE
Address2: STE 103
City: WHITE PLAINS
State: NY
PostalCode: 106042907
CountryCode: US
TelephoneNumber: 8005010388
FaxNumber: 9146812906
Practice Location
Address1: 600 E 233RD ST
Address2:  
City: BRONX
State: NY
PostalCode: 104662604
CountryCode: US
TelephoneNumber: 7189200100
FaxNumber: 7189201549
Other Information
ProviderEnumerationDate: 07/13/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X207992NYY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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