Basic Information
| Provider Information | |||||||||
| NPI: | 1710184635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SARAYA | ||||||||
| FirstName: | IBRAHIM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6134 188TH ST | ||||||||
| Address2: | SUITE 214 | ||||||||
| City: | FRESH MEADOWS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113652726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184544600 | ||||||||
| FaxNumber: | 7184543954 | ||||||||
| Practice Location | |||||||||
| Address1: | 6134 188TH ST | ||||||||
| Address2: | SUITE 214 | ||||||||
| City: | FRESH MEADOWS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113652726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184544600 | ||||||||
| FaxNumber: | 7184543954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 161798 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 01243636 | 05 | NY | MEDICAID |