Provider Demographics
NPI:1407168065
Name:FAROOQ, AFRIN MUSTAFA (MD)
Entity type:Individual
Prefix:
First Name:AFRIN
Middle Name:MUSTAFA
Last Name:FAROOQ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 REEDSDALE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3926
Mailing Address - Country:US
Mailing Address - Phone:617-754-0748
Mailing Address - Fax:617-754-0701
Practice Address - Street 1:199 REEDSDALE RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3926
Practice Address - Country:US
Practice Address - Phone:617-754-0748
Practice Address - Fax:617-754-0701
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-11
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270468208M00000X, 207R00000X
MA258012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03617190Medicaid
NY01131126/RGHMedicaid
NY03007063/NWKMedicaid
NY70005A/RGHMedicare PIN
NY10712A/NWKMedicare PIN
NY03007063/NWKMedicaid
NYJ400090545 NWKMedicare PIN