Provider Demographics
NPI:1578226262
Name:FAROOQ, RIDHA (DC)
Entity Type:Individual
Prefix:DR
First Name:RIDHA
Middle Name:
Last Name:FAROOQ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-3021
Mailing Address - Country:US
Mailing Address - Phone:201-315-7667
Mailing Address - Fax:
Practice Address - Street 1:1629 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-3021
Practice Address - Country:US
Practice Address - Phone:201-315-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor