Healthcare Provider Details

I. General information

NPI: 1699834747
Provider Name (Legal Business Name): FADI JOSEPH BEJJANI MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GENESEE ST
NEW HARTFORD NY
13413-2328
US

IV. Provider business mailing address

100 GENESEE ST
NEW HARTFORD NY
13413-2328
US

V. Phone/Fax

Practice location:
  • Phone: 315-797-1340
  • Fax: 315-797-2403
Mailing address:
  • Phone: 315-797-1340
  • Fax: 315-797-2403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number176944
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number50117
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: