Healthcare Provider Details

I. General information

NPI: 1962922658
Provider Name (Legal Business Name): FATIMA FAYYAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 07/02/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S. SHORE ROAD SUITE 106
MARMORA NJ
08223
US

IV. Provider business mailing address

500 FRANK W BURR BLVD STE 560
TEANECK NJ
07666-6804
US

V. Phone/Fax

Practice location:
  • Phone: 609-390-7888
  • Fax: 609-390-2614
Mailing address:
  • Phone: 201-510-0910
  • Fax: 201-621-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA11981700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: