Provider Demographics
NPI:1619189016
Name:PHYSICIAN HEALTHCARE NETWORK,PC
Entity Type:Organization
Organization Name:PHYSICIAN HEALTHCARE NETWORK,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMSEY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FAKHURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-922-4029
Mailing Address - Street 1:41 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1413
Mailing Address - Country:US
Mailing Address - Phone:516-922-4029
Mailing Address - Fax:718-472-4060
Practice Address - Street 1:4415 43RD AVE APT C1
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2254
Practice Address - Country:US
Practice Address - Phone:718-472-3870
Practice Address - Fax:718-472-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-06
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01410553Medicaid
NYWEK461OtherMEDICARE # FOR NYC, NASSU
NYWEK461OtherMEDICARE # FOR NYC, NASSU
NYDB4454Medicare PIN
NY01410553Medicaid