Healthcare Provider Details

I. General information

NPI: 1184554073
Provider Name (Legal Business Name): FARAH NAZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 RICHMOND RD
STATEN ISLAND NY
10306-2560
US

IV. Provider business mailing address

1835 RICHMOND RD
STATEN ISLAND NY
10306-2560
US

V. Phone/Fax

Practice location:
  • Phone: 718-502-5271
  • Fax: 347-857-6005
Mailing address:
  • Phone: 718-502-5271
  • Fax: 347-857-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number055871
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: