Provider Demographics
NPI:1962922658
Name:FAYYAZ, FATIMA (MD)
Entity type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
Last Name:FAYYAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 FRANK W BURR BLVD STE 560
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6804
Mailing Address - Country:US
Mailing Address - Phone:201-510-0910
Mailing Address - Fax:201-621-6931
Practice Address - Street 1:210 S. SHORE ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223
Practice Address - Country:US
Practice Address - Phone:609-390-7888
Practice Address - Fax:609-390-2614
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA11981700207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty