MEDICARE: MARIAM FAIQ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	060026	NY

General Provider Information

NPI Number	:	1598204265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAM FAIQ DDS

Provider Business Mailing Address
First Line	:	1775 GREAT NECK RD
Second Line	:
City	:	COPIAGUE
State	:	NY
Zip	:	11726-2703
Country	:	US
Telephone Number	:	631-238-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 GREAT NECK RD
Second Line	:
City	:	COPIAGUE
State	:	NY
Zip	:	11726-2703
Country	:	US
Telephone Number	:	631-238-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	01/15/2019

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