Provider Demographics
NPI:1265509616
Name:SAM FARAH MD. LLC
Entity type:Organization
Organization Name:SAM FARAH MD. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-823-0820
Mailing Address - Street 1:3250 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 203A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4500
Mailing Address - Country:US
Mailing Address - Phone:718-823-0820
Mailing Address - Fax:718-823-0821
Practice Address - Street 1:3250 WESTCHESTER AVE
Practice Address - Street 2:SUITE 203A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4500
Practice Address - Country:US
Practice Address - Phone:718-823-0820
Practice Address - Fax:718-823-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203138-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty