Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 192383 | NY |
N | 208600000X | Surgeon | 192383 | NY |
Y | 2086S0102X | Surgical Critical Care | 192383 | NY |
NPI | 1053486985 |
---|---|
Provider Name | Bashar Fahoum |
First Address | Staten Island, NY 10304-1134 |
Second Address | Brooklyn, NY 11215-3609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2006 |
Last Update Date | 10/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01484844 | (05) | NY |
F60912 | (02) | NY |