Healthcare Provider Details

I. General information

NPI: 1548749534
Provider Name (Legal Business Name): FAHAD R SOLAIMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3718 73RD ST FL 5
JACKSON HEIGHTS NY
11372-6265
US

IV. Provider business mailing address

3718 73RD ST FL 5
JACKSON HEIGHTS NY
11372-6265
US

V. Phone/Fax

Practice location:
  • Phone: 347-393-8504
  • Fax:
Mailing address:
  • Phone: 347-393-8504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: