Healthcare Provider Details

I. General information

NPI: 1073936308
Provider Name (Legal Business Name): FAAN MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16806 HILLSIDE AVE
JAMAICA NY
11432-4341
US

IV. Provider business mailing address

278 PARK AVE
WILLISTON PARK NY
11596-1135
US

V. Phone/Fax

Practice location:
  • Phone: 718-739-7400
  • Fax: 718-739-7413
Mailing address:
  • Phone: 718-739-7400
  • Fax: 718-739-7413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number238298
License Number StateNY

VIII. Authorized Official

Name: KHONDEKER RAHMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 718-739-7400