Provider Demographics
NPI:1093738965
Name:FARAH DERMATOLOGY AND COSMETICS LLC
Entity Type:Organization
Organization Name:FARAH DERMATOLOGY AND COSMETICS LLC
Other - Org Name:FARAH DERMATOLOGY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DERMATOLOGIST MD
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMSAY
Authorized Official - Middle Name:SALIM
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-422-4552
Mailing Address - Street 1:1000 E GENESEE ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1892
Mailing Address - Country:US
Mailing Address - Phone:315-422-8331
Mailing Address - Fax:315-422-3129
Practice Address - Street 1:1000 E GENESEE ST
Practice Address - Street 2:SUITE 601
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1892
Practice Address - Country:US
Practice Address - Phone:315-422-8331
Practice Address - Fax:315-422-3129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2172204207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H28807Medicare UPIN
AA0781Medicare ID - Type Unspecified