Provider Demographics
NPI:1467593889
Name:JACKSON HEIGHTS MED OFF
Entity Type:Organization
Organization Name:JACKSON HEIGHTS MED OFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NUZHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:FARIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-426-1000
Mailing Address - Street 1:671 COLLEGE ROAD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738
Mailing Address - Country:US
Mailing Address - Phone:718-426-1000
Mailing Address - Fax:718-426-1100
Practice Address - Street 1:3758 72 STREET
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-426-1000
Practice Address - Fax:718-426-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197647207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty