=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710165295
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FATIMAH U DAWAN DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2008
-----------------------------------------------------
Last Update Date | 03/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 554 GRANT AVE
-----------------------------------------------------
City | NORTH BALDWIN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11510-1329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-486-7789
-----------------------------------------------------
Fax | 929-456-5138
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1681
-----------------------------------------------------
City | BALDWIN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11510-8481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-486-7789
-----------------------------------------------------
Fax | 929-456-5138
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 0293471
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------