Provider Demographics
NPI:1225241169
Name:FATIHA, IBRAHIM (DC , RN, MSN)
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:
Last Name:FATIHA
Suffix:
Gender:M
Credentials:DC , RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4823
Mailing Address - Country:US
Mailing Address - Phone:917-335-9868
Mailing Address - Fax:718-292-1399
Practice Address - Street 1:2242 E 4TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4823
Practice Address - Country:US
Practice Address - Phone:718-569-5458
Practice Address - Fax:718-569-5459
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010318111NR0400X
NY579962163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY666290OtherACN GROUP IPA OF NY
NY666290OtherACN GROUP IPA OF NY