Healthcare Provider Details

I. General information

NPI: 1447407291
Provider Name (Legal Business Name): FIZZA J BOKHARI RD/CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2008
Last Update Date: 08/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SUTTON PL
WHEATLEY HEIGHTS NY
11798-1526
US

IV. Provider business mailing address

3 SUTTON PL
WHEATLEY HEIGHTS NY
11798-1526
US

V. Phone/Fax

Practice location:
  • Phone: 631-920-6246
  • Fax:
Mailing address:
  • Phone: 631-920-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number006571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: