Provider Demographics
NPI:1376866061
Name:FAKIH, MAYA
Entity Type:Individual
Prefix:MRS
First Name:MAYA
Middle Name:
Last Name:FAKIH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 W 59TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1105
Mailing Address - Country:US
Mailing Address - Phone:917-378-1253
Mailing Address - Fax:
Practice Address - Street 1:428 W 59TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1105
Practice Address - Country:US
Practice Address - Phone:212-333-7330
Practice Address - Fax:212-333-7334
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist