Provider Demographics
NPI:1467560656
Name:WASEEM, FAISAL (MD)
Entity Type:Individual
Prefix:
First Name:FAISAL
Middle Name:
Last Name:WASEEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11903 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1322
Mailing Address - Country:US
Mailing Address - Phone:718-441-0184
Mailing Address - Fax:718-441-8098
Practice Address - Street 1:11903 101ST AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1322
Practice Address - Country:US
Practice Address - Phone:718-441-0184
Practice Address - Fax:718-441-8098
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01807496Medicaid
NY03194AMedicare PIN
G64583Medicare UPIN