Provider Demographics
NPI:1427260272
Name:FARRA, NABIL
Entity type:Individual
Prefix:
First Name:NABIL
Middle Name:
Last Name:FARRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3701
Mailing Address - Country:US
Mailing Address - Phone:718-545-6562
Mailing Address - Fax:718-933-3731
Practice Address - Street 1:2543 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3701
Practice Address - Country:US
Practice Address - Phone:718-545-6562
Practice Address - Fax:718-933-3731
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051825-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice