Provider Demographics
NPI:1598926438
Name:FATIMA, FARAH (MD, DO)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:FATIMA
Suffix:
Gender:F
Credentials:MD, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 WILLETS DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3915
Mailing Address - Country:US
Mailing Address - Phone:516-336-8339
Mailing Address - Fax:516-364-1402
Practice Address - Street 1:61 WILLETS DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3915
Practice Address - Country:US
Practice Address - Phone:516-336-8339
Practice Address - Fax:516-364-1402
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260263208M00000X
NY260263-01207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist