Provider Demographics
NPI:1699861567
Name:FARAG, AYMAN ROUSHDY (MD)
Entity type:Individual
Prefix:DR
First Name:AYMAN
Middle Name:ROUSHDY
Last Name:FARAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MARCUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:631-391-8366
Mailing Address - Fax:631-454-4161
Practice Address - Street 1:11 RALPH PL STE 204
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4405
Practice Address - Country:US
Practice Address - Phone:347-286-0741
Practice Address - Fax:347-286-0741
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235487207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology