Basic Information
| Provider Information | |||||||||
| NPI: | 1073936308 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAAN MEDICAL SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 278 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | WILLISTON PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115961135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187397400 | ||||||||
| FaxNumber: | 7187397413 | ||||||||
| Practice Location | |||||||||
| Address1: | 16806 HILLSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114324341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187397400 | ||||||||
| FaxNumber: | 7187397413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2014 | ||||||||
| LastUpdateDate: | 02/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | RAHMAN | ||||||||
| AuthorizedOfficialFirstName: | KHONDEKER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7187397400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 238298 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.