Provider Demographics
NPI:1912722240
Name:MASUD, FARJANA (MBBS)
Entity type:Individual
Prefix:
First Name:FARJANA
Middle Name:
Last Name:MASUD
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 W 44TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2012
Mailing Address - Country:US
Mailing Address - Phone:551-430-9445
Mailing Address - Fax:
Practice Address - Street 1:801 N JAMES ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-3524
Practice Address - Country:US
Practice Address - Phone:315-533-1600
Practice Address - Fax:315-533-1632
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP132685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine