Healthcare Provider Details

I. General information

NPI: 1477945905
Provider Name (Legal Business Name): ELLENVILLE EMERGENCY MEDICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HEALTHY WAY
ELLENVILLE NY
12428-5612
US

IV. Provider business mailing address

PO BOX 80250
PHILADELPHIA PA
19101-1250
US

V. Phone/Fax

Practice location:
  • Phone: 469-401-2386
  • Fax:
Mailing address:
  • Phone: 954-939-5000
  • Fax: 877-250-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FAREED NABIEL FAREED
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 917-854-8007