Healthcare Provider Details

I. General information

NPI: 1922186782
Provider Name (Legal Business Name): KANIZ FATEMA BEGUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137-50 JAMAICA AVE
JAMAICA NY
11435-3610
US

IV. Provider business mailing address

1038 FORDHAM LN
WOODMERE NY
11598-1014
US

V. Phone/Fax

Practice location:
  • Phone: 718-298-5100
  • Fax: 718-298-5128
Mailing address:
  • Phone: 516-791-0852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number219657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: