Healthcare Provider Details

I. General information

NPI: 1912722240
Provider Name (Legal Business Name): FARJANA MASUD MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N JAMES ST
ROME NY
13440-3524
US

IV. Provider business mailing address

71 W 44TH ST FL 1
BAYONNE NJ
07002-2012
US

V. Phone/Fax

Practice location:
  • Phone: 315-533-1600
  • Fax: 315-533-1632
Mailing address:
  • Phone: 551-430-9445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP132685
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: