Provider Demographics
NPI:1215397906
Name:FAYDA MEDICAL CARE PC
Entity Type:Organization
Organization Name:FAYDA MEDICAL CARE PC
Other - Org Name:FAYDA MEDICAL CARE PC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YURY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-322-9721
Mailing Address - Street 1:16204 JAMAICA AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4907
Mailing Address - Country:US
Mailing Address - Phone:347-322-9721
Mailing Address - Fax:
Practice Address - Street 1:16204 JAMAICA AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4907
Practice Address - Country:US
Practice Address - Phone:347-322-9721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172367-1261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care