Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 31TD00382101 | NJ |
NPI | 1093249559 |
---|---|
Provider Name | Majedah Fayed |
First Address | Clifton, NJ 07011-2353 |
Second Address | Clifton, NJ 07011-2353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2017 |
Last Update Date | 11/04/2017 |