Provider Demographics
NPI:1447407291
Name:BOKHARI, FIZZA J (RD/CDN)
Entity Type:Individual
Prefix:
First Name:FIZZA
Middle Name:J
Last Name:BOKHARI
Suffix:
Gender:F
Credentials:RD/CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SUTTON PL
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-1526
Mailing Address - Country:US
Mailing Address - Phone:631-920-6246
Mailing Address - Fax:
Practice Address - Street 1:3 SUTTON PL
Practice Address - Street 2:
Practice Address - City:WHEATLEY HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11798-1526
Practice Address - Country:US
Practice Address - Phone:631-920-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-23
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006571133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered