Provider Demographics
NPI:1285811158
Name:FAHEEM ABBASI LLC
Entity type:Organization
Organization Name:FAHEEM ABBASI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAHEEM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABBASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-565-3777
Mailing Address - Street 1:2090 STATE ROUTE 27
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1141
Mailing Address - Country:US
Mailing Address - Phone:732-565-3777
Mailing Address - Fax:732-746-0223
Practice Address - Street 1:2090 STATE ROUTE 27
Practice Address - Street 2:SUITE 103
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1141
Practice Address - Country:US
Practice Address - Phone:732-565-3777
Practice Address - Fax:732-746-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08038100261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
H67038Medicare UPIN