Healthcare Provider Details

I. General information

NPI: 1912314881
Provider Name (Legal Business Name): FAROOQ KAZI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2014
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 2ND AVE
BROOKLYN NY
11215-2711
US

IV. Provider business mailing address

1670 E 17TH ST 3RD FLOOR
BROOKLYN NY
11229-1281
US

V. Phone/Fax

Practice location:
  • Phone: 718-514-6007
  • Fax:
Mailing address:
  • Phone: 718-233-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007075
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: