Healthcare Provider Details

I. General information

NPI: 1942099239
Provider Name (Legal Business Name): AYESHA FATIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 TEANECK RD,
TEANECK NJ
07666
US

IV. Provider business mailing address

718 TEANECK RD, INTERNAL MEDICINE RESIDENCY PROGRAM HOL
TEANECK NJ
07666
US

V. Phone/Fax

Practice location:
  • Phone: 201-833-7041
  • Fax:
Mailing address:
  • Phone: 201-833-7041
  • 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: