Provider Demographics
NPI:1245205855
Name:ELMENIAWY-FARAG, GIHAN MAKRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GIHAN
Middle Name:MAKRAM
Last Name:ELMENIAWY-FARAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GIHAN
Other - Middle Name:MAKRAM
Other - Last Name:FARAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:26 ALGONKIN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4302
Mailing Address - Country:US
Mailing Address - Phone:718-605-8155
Mailing Address - Fax:718-948-1787
Practice Address - Street 1:5091 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-4722
Practice Address - Country:US
Practice Address - Phone:718-948-6621
Practice Address - Fax:718-948-1787
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02671630Medicaid
NY135SH1Medicare ID - Type Unspecified
NYI35399Medicare UPIN