Healthcare Provider Details

I. General information

NPI: 1811831712
Provider Name (Legal Business Name): DUA FATIMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

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

1021 66TH ST
BROOKLYN NY
11219-5906
US

IV. Provider business mailing address

1021 66TH ST
BROOKLYN NY
11219-5906
US

V. Phone/Fax

Practice location:
  • Phone: 443-413-3703
  • Fax:
Mailing address:
  • Phone: 443-413-3703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RAJA MUHAMMAD TABISH KHAN
Title or Position: OWNER
Credential:
Phone: 443-413-3703