MEDICARE: FAJAR CORP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1073142980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAJAR CORP LLC

Provider Business Mailing Address
First Line	:	2991 RAYWOOD ASH DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6143
Country	:	US
Telephone Number	:	201-737-6717
Fax Number	:	702-446-6343

Provider Business Practice Location Address
First Line	:	2991 RAYWOOD ASH DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6143
Country	:	US
Telephone Number	:	201-737-6717
Fax Number	:	702-446-6343

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SALMAN ARIF
Credential	:	MD
Telephone Number	:	201-737-6717

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	04/02/2020

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