Provider Demographics
NPI:1447448758
Name:FARAH DERMATOLOGY & COSMETICS LLC
Entity type:Organization
Organization Name:FARAH DERMATOLOGY & COSMETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-593-2730
Mailing Address - Street 1:120 CAYUGA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1742
Mailing Address - Country:US
Mailing Address - Phone:315-593-2730
Mailing Address - Fax:315-422-3129
Practice Address - Street 1:120 CAYUGA ST
Practice Address - Street 2:SUITE A
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1742
Practice Address - Country:US
Practice Address - Phone:315-593-2730
Practice Address - Fax:315-422-3129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FARAH DERMATOLOGY & COSMETICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-11
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225658-1207N00000X
NY132825-1207N00000X
NY217220-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1770597858OtherNPI DR RAMSAY FARAH
NY1669486734OtherNPI DR FUAD FARAH
NY1669699336OtherNPI DR JOYCE FARAH 1669699336
NY1669699336OtherNPI DR JOYCE FARAH 1669699336