1467610071 NPI number — AYMAN E. FARID, MD LLC

Table of content: (NPI 1467610071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467610071 NPI number — AYMAN E. FARID, MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AYMAN E. FARID, MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467610071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5091 AMBOY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10312-4722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-984-2100
Provider Business Mailing Address Fax Number:
718-317-6582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5091 AMBOY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10312-4722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-984-2100
Provider Business Practice Location Address Fax Number:
718-317-6582
Provider Enumeration Date:
05/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FARID
Authorized Official First Name:
AYMAN
Authorized Official Middle Name:
EMIL
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
718-984-2100

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  196044 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 21N932 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5068480 . This is a "AETNA SPECIALTY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P537126 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 807706 . This is a "AETNA PRIMARY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 149806P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01648984 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2102085 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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