Provider Demographics
NPI:1861812646
Name:FA SURGICAL PLLC
Entity Type:Organization
Organization Name:FA SURGICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:FARUQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:929-777-0680
Mailing Address - Street 1:17520 WEXFORD TER APT 16T
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2838
Mailing Address - Country:US
Mailing Address - Phone:929-777-0680
Mailing Address - Fax:516-706-6026
Practice Address - Street 1:3728 77TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6630
Practice Address - Country:US
Practice Address - Phone:929-777-0680
Practice Address - Fax:516-706-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241611208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty