Provider Demographics
NPI:1649051517
Name:FARZANA, MUNMUN
Entity type:Individual
Prefix:
First Name:MUNMUN
Middle Name:
Last Name:FARZANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 ITHACA ST APT 4H
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3413
Mailing Address - Country:US
Mailing Address - Phone:646-708-1317
Mailing Address - Fax:
Practice Address - Street 1:4242 ITHACA ST APT 4H
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3413
Practice Address - Country:US
Practice Address - Phone:646-708-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-P125255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine