Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 281868 | NY |
N | 213ES0000X | Sports Medicine | 281868 | NY |
NPI | 1558594929 |
---|---|
Provider Name | Dr. Faruk Razzak |
First Address | Smithtown, NY 11787-2916 |
Second Address | Smithtown, NY 11787-2916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2009 |
Last Update Date | 24/06/2021 |