Provider Demographics
NPI:1225672298
Name:FAHMY-HAWASH, MARIAN (APN)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:FAHMY-HAWASH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WYANDOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2119
Mailing Address - Country:US
Mailing Address - Phone:732-794-0031
Mailing Address - Fax:
Practice Address - Street 1:266 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4026
Practice Address - Country:US
Practice Address - Phone:973-340-6225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-03
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345167363LF0000X
NJ26NJ00952900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily