Healthcare Provider Details

I. General information

NPI: 1720194012
Provider Name (Legal Business Name): FOR-MED MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 31ST AVE
LONG ISLAND CITY NY
11106-3607
US

IV. Provider business mailing address

2535 31ST AVE
LONG ISLAND CITY NY
11106-3607
US

V. Phone/Fax

Practice location:
  • Phone: 718-274-2600
  • Fax: 718-274-5337
Mailing address:
  • Phone: 718-274-2600
  • Fax: 718-274-5337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: FOUAD LAJAM
Title or Position: OWNER
Credential: M.D.
Phone: 718-274-2600