To request an appointment using our website, please complete the form below. After you submit this information, a representative will contact you by phone within two business days. If you have a medical emergency, dial 911.
Dr. Samira Farouk
25-20 30th Avenue
Long Island City, NY 11102 212-659-8086
Please enter a First Name
Please enter a Last Name
Please complete Address Line 1
Please enter a City
Please enter your 10 digit phone number with no spaces or characters. (ex: 5551234567)
You must provide a valid email
Please provide a Date of Birth (ex: MM/DD/YYYY)
Preferred Contact Time* (EST)
Preferred Contact Time is required
Please select your insurance provider from the list of plans accepted within the Mount Sinai Health System. Accepted insurance may vary by the doctor, office location and type of service.
Do you need assistance making an appointment?
Please Call 1-800-637-4624