MEDICARE: DR. MOHAMED FAHMI AL-BASHIR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	72291	NJ
2	208600000X	Surgery Physician	215854	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174515761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMED FAHMI AL-BASHIR MD

Provider Business Mailing Address
First Line	:	517 68TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-6003
Country	:	US
Telephone Number	:	718-986-7734
Fax Number	:	201-795-9157

Provider Business Practice Location Address
First Line	:	550 NEWARK AVE
Second Line	:	SUITE 200
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-1326
Country	:	US
Telephone Number	:	201-795-9155
Fax Number	:	201-795-9157

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2007

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