Provider Demographics
NPI:1538493416
Name:CENTEREACH MEDICAL OFFICE P.C.
Entity Type:Organization
Organization Name:CENTEREACH MEDICAL OFFICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NUZHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:FARIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-398-4310
Mailing Address - Street 1:671 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1358
Mailing Address - Country:US
Mailing Address - Phone:631-398-4310
Mailing Address - Fax:718-426-1100
Practice Address - Street 1:18 EASTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2735
Practice Address - Country:US
Practice Address - Phone:631-467-3600
Practice Address - Fax:718-426-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty