Healthcare Provider Details

I. General information

NPI: 1528602000
Provider Name (Legal Business Name): IRINE FARAG LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HEMPSTEAD TPKE
FARMINGDALE NY
11735-2034
US

IV. Provider business mailing address

73 JESTER LN
LEVITTOWN NY
11756-5236
US

V. Phone/Fax

Practice location:
  • Phone: 516-755-5855
  • Fax:
Mailing address:
  • Phone: 860-941-7927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number031475
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: