Provider Demographics
NPI:1689745465
Name:KOREISHI, FARUK MOINUDDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:FARUK
Middle Name:MOINUDDIN
Last Name:KOREISHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1176 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2102
Mailing Address - Country:US
Mailing Address - Phone:716-881-7978
Mailing Address - Fax:716-887-2991
Practice Address - Street 1:6637 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5974
Practice Address - Country:US
Practice Address - Phone:716-632-1595
Practice Address - Fax:716-204-4895
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2016-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY119187207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00615898Medicaid
NYB36007Medicare UPIN