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General NPI Number Information
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NPI Number | 1538493416
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Entity Type | Organization
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Legal Business Name | CENTEREACH MEDICAL OFFICE P.C.
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 18 EASTWOOD BLVD
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City | CENTEREACH
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State | NY
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Zip | 11720-2735
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Country | US
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Telephone | 631-467-3600
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Fax | 718-426-1100
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Provider Business Mailing Address
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Address Line | 671 COLLEGE RD
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City | FARMINGVILLE
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State | NY
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Zip | 11738-1358
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Country | US
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Telephone | 631-398-4310
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Fax | 718-426-1100
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NUZHAT FARIDI
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Credential | M.D.
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Telephone | 631-398-4310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 197647
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License Number State | NY
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