Provider Demographics
NPI:1265657647
Name:FAHEEM, AYMAN A (MD)
Entity Type:Individual
Prefix:
First Name:AYMAN
Middle Name:A
Last Name:FAHEEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-2135
Mailing Address - Country:US
Mailing Address - Phone:732-240-7566
Mailing Address - Fax:732-240-2298
Practice Address - Street 1:1717 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-2135
Practice Address - Country:US
Practice Address - Phone:732-240-7566
Practice Address - Fax:732-240-2298
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05985200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics