Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 25MB10798400 | NJ |
Y | 111NI0900X | Internist | 25MB10798400 | NJ |
NPI | 1003346206 |
---|---|
Provider Name | Dr. Antonious Sherif Fawzy |
First Address | Tinton Falls, NJ 07753-7639 |
Second Address | Brick, NJ 08724-7732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2017 |
Last Update Date | 14/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0732389 | (05) | NJ |