Provider Demographics
NPI:1558594929
Name:RAZZAK, FARUK (DO)
Entity Type:Individual
Prefix:DR
First Name:FARUK
Middle Name:
Last Name:RAZZAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 E MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2916
Mailing Address - Country:US
Mailing Address - Phone:631-361-5302
Mailing Address - Fax:
Practice Address - Street 1:290 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2916
Practice Address - Country:US
Practice Address - Phone:631-361-5302
Practice Address - Fax:631-361-8607
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2818682081S0010X, 208VP0014X, 208VP0014X
NJ25MB09405900208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine