Basic Information
| Provider Information | |||||||||
| NPI: | 1083734123 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAIK BARAK PETERS | ||||||||
| FirstName: | MHROOS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | POB 1319 | ||||||||
| Address2: | |||||||||
| City: | PORT WASHINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110507319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166292154 | ||||||||
| FaxNumber: | 5166292452 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 PORT WASHINGTON BLVD. | ||||||||
| Address2: | SAINT FRANCIS HOSPITALISTS | ||||||||
| City: | ROSLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115761347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165626385 | ||||||||
| FaxNumber: | 5165626300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 10/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 249349 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 03037390 | 05 | NY | MEDICAID |