Healthcare Provider Details

I. General information

NPI: 1568646875
Provider Name (Legal Business Name): FAIUNA NYARA HASEEB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 SEGUINE AVE
STATEN ISLAND NY
10309-3932
US

IV. Provider business mailing address

1 EDGEWATER ST 6TH FLOOR
STATEN ISLAND NY
10305-4907
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9488
  • Fax: 718-226-8132
Mailing address:
  • Phone: 718-226-1047
  • Fax: 718-226-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number251062
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: