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General NPI Number Information
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NPI Number | 1780621516
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Entity Type | Organization
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Legal Business Name | WYCKOFF FAMILY MEDICAL SERVICES P C
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 374 STOCKHOLM ST C/O FACULTY PRACTICE MANAGEMENT- SUITE 1-37 N
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City | BROOKLYN
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State | NY
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Zip | 11237-4006
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Country | US
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Telephone | 718-963-6485
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Fax | 718-963-6793
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Provider Business Mailing Address
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Address Line | 374 STOCKHOLM ST C/O FACULTY PRACTICE MANAGEMENT- SUITE 1-37 N
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City | BROOKLYN
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State | NY
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Zip | 11237-4006
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Country | US
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Telephone | 718-963-6485
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Fax | 718-963-6793
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Authorized Official
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Title or Position | DIRECTOR/OFFICER
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Name | DR. FARIDEH ZONOUZI-ZADEH
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Credential | M.D.
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Telephone | 718-963-6485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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