Provider Demographics
NPI:1861467250
Name:FARAG, SHERIF A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERIF
Middle Name:A
Last Name:FARAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ALGONKIN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4302
Mailing Address - Country:US
Mailing Address - Phone:718-605-8155
Mailing Address - Fax:
Practice Address - Street 1:5091 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-4722
Practice Address - Country:US
Practice Address - Phone:718-948-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213601207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02022457Medicaid
NY796921Medicare ID - Type Unspecified
NYG99942Medicare UPIN