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General NPI Number Information
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NPI Number | 1801320965
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Entity Type | Individual
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Provider Name | SHAZIM FAROOQ DDS
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Gender | Male
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Dates
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Enumeration Date | 04/16/2017
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 3905 61ST ST
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City | FLUSHING
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State | NY
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Zip | 11377-3566
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Country | US
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Telephone | 718-940-4404
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Fax |
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Provider Business Mailing Address
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Address Line | 1 STONLEA CT
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City | NANUET
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State | NY
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Zip | 10954-5927
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Country | US
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Telephone | 845-709-0943
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 061023
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License Number State | NY
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