Provider Demographics
NPI:1043637192
Name:SUMREIN, FADWA (DO)
Entity Type:Individual
Prefix:DR
First Name:FADWA
Middle Name:
Last Name:SUMREIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BRIGHTON RD STE 400
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1670
Mailing Address - Country:US
Mailing Address - Phone:862-297-9696
Mailing Address - Fax:862-297-9695
Practice Address - Street 1:2 BRIGHTON RD STE 400
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012
Practice Address - Country:US
Practice Address - Phone:862-297-9696
Practice Address - Fax:862-297-9695
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10591700207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism