Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 010318 | NY |
NPI | 1225241169 |
---|---|
Provider Name | Ibrahim Fatiha |
First Address | Brooklyn, NY 11223-4823 |
Second Address | Brooklyn, NY 11223-4823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 20/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
666290 | ACN GROUP IPA OF NY (01) | NY |