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General NPI Number Information
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NPI Number | 1639434061
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Entity Type | Organization
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Legal Business Name | FAR ROCKAWAY MEDICAL PC
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 712 BEACH 20TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-3502
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Country | US
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Telephone | 718-327-7457
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Fax | 718-327-7539
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Provider Business Mailing Address
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Address Line | 712 BEACH 20TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-3502
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Country | US
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Telephone | 718-327-7457
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Fax | 718-327-7539
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Authorized Official
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Title or Position | OWNER
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Name | JEAN-PIERRE BARAKAT
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Credential | MD
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Telephone | 718-327-7457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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