Healthcare Provider Details

I. General information

NPI: 1558708057
Provider Name (Legal Business Name): FA SURGICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MAIN ST FLOOR 1
WARSAW NY
14569-1025
US

IV. Provider business mailing address

275 NORTHPOINTE PKWY SUITE 50
AMHERST NY
14228-1895
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-8940
  • Fax: 585-786-1241
Mailing address:
  • Phone: 716-834-1193
  • Fax: 716-639-1382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number241611
License Number StateNY

VIII. Authorized Official

Name: FARUQUE AHMED
Title or Position: OWNER
Credential: D.O.
Phone: 585-786-8940