MEDICARE: FAR ROCKAWAY MEDICAL PC

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	363A00000X	Physician Assistant
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1639434061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAR ROCKAWAY MEDICAL PC

Provider Business Mailing Address
First Line	:	712 BEACH 20TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3502
Country	:	US
Telephone Number	:	718-327-7457
Fax Number	:	718-327-7539

Provider Business Practice Location Address
First Line	:	712 BEACH 20TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3502
Country	:	US
Telephone Number	:	718-327-7457
Fax Number	:	718-327-7539

Authorized Official
Title or Position	:	OWNER
Name	:	JEAN-PIERRE BARAKAT
Credential	:	MD
Telephone Number	:	718-327-7457

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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