Provider Demographics
NPI:1912039405
Name:FOREST HILLS SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:FOREST HILLS SURGICAL ASSOCIATES PC
Other - Org Name:FOREST HILLS SURGICAL ASSOCIATES PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-544-0918
Mailing Address - Street 1:11042 72ND RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-8303
Mailing Address - Country:US
Mailing Address - Phone:718-544-0918
Mailing Address - Fax:718-544-0919
Practice Address - Street 1:11042 72ND RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-8303
Practice Address - Country:US
Practice Address - Phone:718-544-0918
Practice Address - Fax:718-544-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136142208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty