Healthcare Provider Details

I. General information

NPI: 1699710558
Provider Name (Legal Business Name): FAYEZ MIKHAIL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MAYFAIR RD
SOUTHAMPTON NJ
08088-1014
US

IV. Provider business mailing address

23 MAYFAIR RD
SOUTHAMPTON NJ
08088-1014
US

V. Phone/Fax

Practice location:
  • Phone: 609-587-1001
  • Fax: 302-239-2105
Mailing address:
  • Phone: 609-587-1001
  • Fax: 302-239-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FAYEZ MIKHAIL
Title or Position: PROVIDER
Credential: MD
Phone: 609-587-1001