MEDICARE: FATMA BOUZAIENE RN

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	163WS0200X	School Registered Nurse	733212	NY

General Provider Information

NPI Number	:	1790630267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATMA BOUZAIENE RN

Provider Business Mailing Address
First Line	:	2405 FIRE AVE
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-1789
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 FOREST AVE
Second Line	:
City	:	WEST BABYLON
State	:	NY
Zip	:	11704-5131
Country	:	US
Telephone Number	:	631-321-0300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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