Healthcare Provider Details

I. General information

NPI: 1861550626
Provider Name (Legal Business Name): FARAH M ALAM D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MORRIS PARK AVE
BRONX NY
10461-1949
US

IV. Provider business mailing address

1410 PELHAM PKWY S
BRONX NY
10461-1116
US

V. Phone/Fax

Practice location:
  • Phone: 718-839-7085
  • Fax: 718-862-1880
Mailing address:
  • Phone: 718-430-8600
  • Fax: 718-892-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number048762
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: