Provider Demographics
NPI:1780868885
Name:MANSOOB, FARHANA (MD)
Entity type:Individual
Prefix:
First Name:FARHANA
Middle Name:
Last Name:MANSOOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SOUTH SHORE ASSOCIATION FOR INDEPENDENT LIVING, INC.
Mailing Address - Street 2:1976 GRAND AVENUE
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510
Mailing Address - Country:US
Mailing Address - Phone:516-855-1800
Mailing Address - Fax:516-855-1811
Practice Address - Street 1:SOUTH SHORE ASSOCIATION FOR INDEPENDENT LIVING, INC.
Practice Address - Street 2:1976 GRAND AVENUE
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510
Practice Address - Country:US
Practice Address - Phone:516-855-1800
Practice Address - Fax:516-855-1811
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238665-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry