Fadi Niazy Abu-Farsakh, MD
Individual provider Active NPI Geriatric Medicine (Internal Medicine) Physician · New Orleans, LA
NPI 1487215950 · NPPES record last updated Jul 18, 2022
Key facts
- NPI
- 1487215950
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician 207RG0300X
- License
- 4301507530 (MI)
- Practice address
- 1542 Tulane Ave
Box T4M-2
New Orleans, LA 70112 - Phone
- (504) 478-6877
- NPI assigned
- Jun 25, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230822001674 | MI | Practitioner - Internal Medicine | 3375871254 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301507530 | MI | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospice and Palliative Medicine (Internal Medicine) Physician | 207RH0002X | 4301507530 | MI | |
| General Practice Physician | 208D00000X | 4301507530 | MI | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | 320211 | LA | |
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 4301507530 | MI | Yes |
Addresses
Primary practice location
1542 Tulane Ave
Box T4M-2
New Orleans, LA 70112
Mailing address
3960 Mayfield Ave NE Apt 2G
Grand Rapids, MI 49525-6612
Phone (504) 478-6877
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2503201 | Medicaid | LA |
Other providers in New Orleans, LA
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- Jonathan Jacob Abraham
- Andrew Abreo
- Sarah Grundmeyer Abrusley
- Absolutecare of Louisiana, LLC
- Tunde A Abubakar
- Abundance Health Care Services, LLC
- Abundant Counseling Services Algiers LLC
- Abundant Home Health, Inc.
- Abundant Life Adult Day Health LLC
All providers in New Orleans, LA · Geriatric Medicine (Internal Medicine) Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.