Healthcare Provider Details

I. General information

NPI: 1932132388
Provider Name (Legal Business Name): FARHEEN GAFFAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MANOR PL
GREENPORT NY
11944-1222
US

IV. Provider business mailing address

13717 79TH ST
HOWARD BEACH NY
11414-1111
US

V. Phone/Fax

Practice location:
  • Phone: 631-477-5466
  • Fax:
Mailing address:
  • Phone: 917-566-0285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number007289
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: