Basic Information
Provider Information
NPI: 1720047053
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARHISCAR
FirstName: AFSHIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 32346
Address2:  
City: HARTFORD
State: CT
PostalCode: 06150
CountryCode: US
TelephoneNumber: 2122563682
FaxNumber:  
Practice Location
Address1: 134 ATLANTIC AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 11201
CountryCode: US
TelephoneNumber: 7182221030
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/23/2006
LastUpdateDate: 08/30/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2086S0122X224545NYY Allopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery

ID Information
IDTypeStateIssuerDescription
0228511005NY MEDICAID


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