Provider Demographics
NPI:1962882316
Name:DOMINIC S FARNAN
Entity type:Organization
Organization Name:DOMINIC S FARNAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-328-4103
Mailing Address - Street 1:540 E 5TH ST
Mailing Address - Street 2:17
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6529
Mailing Address - Country:US
Mailing Address - Phone:347-328-4103
Mailing Address - Fax:
Practice Address - Street 1:540 E 5TH ST
Practice Address - Street 2:17
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-6529
Practice Address - Country:US
Practice Address - Phone:347-328-4103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036975261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy