Healthcare Provider Details

I. General information

NPI: 1487841110
Provider Name (Legal Business Name): ESRA FAKIOGLU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18904 UNION TPKE FL 1
FRESH MEADOWS NY
11366-1862
US

IV. Provider business mailing address

18904 UNION TPKE FL 1
FRESH MEADOWS NY
11366-1862
US

V. Phone/Fax

Practice location:
  • Phone: 347-230-2454
  • Fax: 646-580-0908
Mailing address:
  • Phone: 347-230-2454
  • Fax: 646-580-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number266365
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number266365
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number266365
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: