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General NPI Number Information
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NPI Number | 1972652576
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Entity Type | Organization
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Legal Business Name | FARMINGVILLE MEDICAL CARE, PLLC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 445 BROADHOLLOW RD STE 25
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City | MELVILLE
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State | NY
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Zip | 11747-3645
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Country | US
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Telephone | 631-202-9011
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Fax | 503-386-2841
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Provider Business Mailing Address
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Address Line | 445 BROADHOLLOW RD STE 25
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City | MELVILLE
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State | NY
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Zip | 11747-3645
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Country | US
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Telephone | 631-202-9011
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Fax | 503-386-2841
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Authorized Official
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Title or Position | OWNER
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Name | DR. ARARY B CANAVARROS
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Credential | M.D.
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Telephone | 631-202-9011
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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 | 222080-1
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License Number State | NY
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