Healthcare Provider Details

I. General information

NPI: 1073458956
Provider Name (Legal Business Name): LILY HAFEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: FIKUS GRAY

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL STE 1
BOSTON MA
02118-2999
US

IV. Provider business mailing address

106 BRIGADOON BLVD
HIGHLAND MILLS NY
10930-8312
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8000
  • Fax:
Mailing address:
  • Phone: 845-674-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: