NPIMap

Organization Active NPI

Craft Behavioral Health Clinic

Doing business as Craft Laser Clinic

  • Technician
  • Jacksonville, FL
National Provider Identifier
1184308108
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
TechnicianTaxonomy code 374700000X
Legal business name
CRAFT BEHAVIORAL HEALTH CLINIC
Doing business as
Craft Laser Clinic
Practice address
10175 Fortune Pkwy Unit 1106
Jacksonville, FL 32256-6757
Phone
(904) 337-0768
Fax
(904) 379-5967
NPI assigned
Jun 12, 2023
Last updated
Jun 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mohammed Farooque, MD, PHD
Title
Owner/Doctor
Phone
(904) 379-5928

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Technician 374700000X NU Primary

Addresses

Primary practice location

10175 Fortune Pkwy Unit 1106
Jacksonville, FL 32256-6757

Mailing address

10175 Fortune Pkwy Unit 1106
Jacksonville, FL 32256-6757
Phone (904) 337-0768

Other identifiers 1

IdentifierTypeStateIssuer
EO2233OtherFLDEPARTMENT OF HEALTH ELECTROLOGIST LICENSE

Other names 1

  • Craft Laser Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1184308108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10175 FORTUNE PKWY UNIT 1106",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566757",
            "telephone_number": "904-337-0768",
            "fax_number": "904-379-5967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10175 FORTUNE PKWY UNIT 1106",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566757",
            "telephone_number": "904-337-0768",
            "fax_number": "904-379-5967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRAFT BEHAVIORAL HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-10",
        "status": "A",
        "authorized_official_last_name": "FAROOQUE",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "904-379-5928",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "374700000X",
            "taxonomy_group": "",
            "desc": "Technician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF HEALTH ELECTROLOGIST LICENSE",
            "identifier": "EO2233",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Craft Laser Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.