Provider Demographics
NPI:1699710558
Name:FAYEZ MIKHAIL, LLC
Entity type:Organization
Organization Name:FAYEZ MIKHAIL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:FAYEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-587-1001
Mailing Address - Street 1:23 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-1014
Mailing Address - Country:US
Mailing Address - Phone:609-587-1001
Mailing Address - Fax:302-239-2105
Practice Address - Street 1:23 MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08088-1014
Practice Address - Country:US
Practice Address - Phone:609-587-1001
Practice Address - Fax:302-239-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3594006Medicaid
NJ0K0104OtherHEALTHNET
NJ110027952OtherRAIL ROAD MEDICARE
NJP421119OtherOXFORD
NJ0212428000OtherAMERIHEALTH
NJ1024394OtherMERCY
NJ83916OtherAMERICAID
NJ9100008422OtherAMERICHOICE
NJ0533633OtherAETNA
NJ1024394OtherMERCY