Provider Demographics
NPI:1215992177
Name:FAKHURI, RAMSEY JOHN (MD)
Entity type:Individual
Prefix:
First Name:RAMSEY
Middle Name:JOHN
Last Name:FAKHURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732
Mailing Address - Country:US
Mailing Address - Phone:516-922-4029
Mailing Address - Fax:
Practice Address - Street 1:4415 43RD AVE APT C1
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2254
Practice Address - Country:US
Practice Address - Phone:718-472-3870
Practice Address - Fax:718-472-4060
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01410553Medicaid
F16904Medicare UPIN
NYP00105413Medicare PIN
NY021AI1Medicare PIN
04691Medicare ID - Type UnspecifiedGHI MEDICARE QUEENS NY