Provider Demographics
NPI:1720194012
Name:FOR-MED MEDICAL
Entity Type:Organization
Organization Name:FOR-MED MEDICAL
Other - Org Name:ASTORIA MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FOUAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LAJAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-274-2600
Mailing Address - Street 1:2535 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3607
Mailing Address - Country:US
Mailing Address - Phone:718-274-2600
Mailing Address - Fax:718-274-5337
Practice Address - Street 1:2535 31ST AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-3607
Practice Address - Country:US
Practice Address - Phone:718-274-2600
Practice Address - Fax:718-274-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00672642Medicaid
NY37252Medicare ID - Type Unspecified