Healthcare Provider Details

I. General information

NPI: 1447023072
Provider Name (Legal Business Name): DR. SAIFUDHEEN FAROOG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST # 8C32
BRONX NY
10451-5589
US

IV. Provider business mailing address

234 E 149TH ST # 8C32
BRONX NY
10451-5589
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-4739
  • Fax:
Mailing address:
  • Phone: 718-579-4739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47434
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number10219202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: