Provider Demographics
NPI:1043256928
Name:SYED-KHAN, FAUZIA F (MD)
Entity Type:Individual
Prefix:DR
First Name:FAUZIA
Middle Name:F
Last Name:SYED-KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 29TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3503
Mailing Address - Country:US
Mailing Address - Phone:718-274-0105
Mailing Address - Fax:718-274-2671
Practice Address - Street 1:3435 29TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3503
Practice Address - Country:US
Practice Address - Phone:718-274-0105
Practice Address - Fax:718-274-2671
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228656207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02548483Medicaid
NY02548483Medicaid
NYI00582Medicare UPIN