Healthcare Provider Details

I. General information

NPI: 1679414858
Provider Name (Legal Business Name): MAHNOOR FATIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST RM 4-20
BRONX NY
10451-5504
US

IV. Provider business mailing address

234 E 149TH ST RM 4-20
BRONX NY
10451-5504
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5030
  • Fax: 718-579-4700
Mailing address:
  • Phone: 718-579-5030
  • Fax: 718-579-4700

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: