Provider Demographics
NPI:1255467619
Name:FARID, OSAMA (PA)
Entity Type:Individual
Prefix:MR
First Name:OSAMA
Middle Name:
Last Name:FARID
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5091 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4722
Mailing Address - Country:US
Mailing Address - Phone:718-984-2100
Mailing Address - Fax:718-317-6582
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:718-984-2100
Practice Address - Fax:718-317-6582
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1072558363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical