Provider Demographics
NPI:1902058357
Name:FARIS AL-GEBORY MD
Entity type:Organization
Organization Name:FARIS AL-GEBORY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LETY
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-416-4389
Mailing Address - Street 1:209-10 RICHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11364
Mailing Address - Country:US
Mailing Address - Phone:646-812-6044
Mailing Address - Fax:718-416-3652
Practice Address - Street 1:70-31A 108TH STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:646-812-6044
Practice Address - Fax:718-416-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243497208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY243497OtherLICENSE
NYA300000256Medicare PIN
NYG300000049Medicare PIN