MEDICARE: DR. AYMAN ROUSHDY FARAG MD

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	208VP0014X	Interventional Pain Medicine Physician	235487	NY
2	207L00000X	Anesthesiology Physician	235487	NY

General Provider Information

NPI Number	:	1699861567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AYMAN ROUSHDY FARAG MD

Provider Business Mailing Address
First Line	:	80 MARCUS DR
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-4230
Country	:	US
Telephone Number	:	631-391-8366
Fax Number	:	631-454-4161

Provider Business Practice Location Address
First Line	:	11 RALPH PL STE 204
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4405
Country	:	US
Telephone Number	:	347-286-0741
Fax Number	:	347-286-0741

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	03/06/2026

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