Provider Demographics
NPI:1003563560
Name:FAISAL RAFIQ, MD, PC
Entity type:Organization
Organization Name:FAISAL RAFIQ, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-440-1010
Mailing Address - Street 1:120 BROADWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701
Mailing Address - Country:US
Mailing Address - Phone:718-924-7444
Mailing Address - Fax:516-879-3099
Practice Address - Street 1:120 BROADWAY
Practice Address - Street 2:SUITE D
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701
Practice Address - Country:US
Practice Address - Phone:631-440-1010
Practice Address - Fax:631-237-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY271401OtherMEDICAL LICENSE