Healthcare Provider Details

I. General information

NPI: 1730397670
Provider Name (Legal Business Name): GIAS MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5091 AMBOY ROAD
STATEN ISLAND NY
10312
US

IV. Provider business mailing address

5091 AMBOY ROAD
STATEN ISLAND NY
10312
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-0221
  • Fax: 718-948-1787
Mailing address:
  • Phone: 718-948-0221
  • Fax: 718-948-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHERIF ADIB FARAG
Title or Position: CO-OWNER
Credential: MD
Phone: 718-948-0221