Individual provider Active NPI

Faisal Muhammad Rafiq, M.D.

  • Psychiatry Physician
  • Amityville, NY
National Provider Identifier
1770734238
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
271401 Issued in NY
Practice address
120 Broadway Ste D
Amityville, NY 11701-2762
Phone
(631) 440-1010
Fax
(516) 879-3099
NPI assigned
Oct 2, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 271401 NY Primary

Addresses

Primary practice location

120 Broadway Ste D
Amityville, NY 11701-2762

Mailing address

120 Broadway Ste D
Amityville, NY 11701-2762
Phone (631) 440-1010

Other identifiers 1

IdentifierTypeStateIssuer
03708647MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, WI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130827000452 NY Practitioner - Psychiatry 7214170042 Reassigns benefits to 1 organization
I20150629002451 WI Practitioner - Psychiatry 7214170042 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Faisal Rafiq MD PCGroup PAC ID 7618361627, 4 clinicians

Practice addresses (Care Compare)

120 Broadway
Suite D
Amityville, NY 11701-2762
Phone (631) 440-1010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
271401NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faisal Rafiq, MD, PC Psychiatry CurrentSince Jan 1, 2022 Accepting new patients
Ascension Medical Group-Southeast Wisconsin Inc CurrentSince Jun 22, 2015 Accepting new patients
Faisal Rafiq MD. PC Psychiatry Past Accepting new patients

Locations

1873 Western Ave
Ste 202
Albany, NY 12203
Phone (518) 605-7505

120 Broadway
Ste D
Amityville, NY 11701
Phone (631) 440-1010

120 Broadway
Amityville, NY 11701
Phone (516) 605-7505

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

3801 Spring St
Mount Pleasant, WI 53405
Phone (262) 636-4011

1320 Wisconsin Ave
Racine, WI 53403
Phone (262) 687-2222

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1222905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646697600000",
    "number": "1770734238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 BROADWAY STE D",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012762",
            "telephone_number": "631-440-1010",
            "fax_number": "516-879-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 BROADWAY STE D",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012762",
            "telephone_number": "631-440-1010",
            "fax_number": "516-879-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAFIQ",
        "first_name": "FAISAL",
        "middle_name": "MUHAMMAD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-02",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "271401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03708647",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Amityville, NY

Sources for this page

Verify at the official NPI Registry.