Provider Demographics
NPI:1659811438
Name:BOUKHEIR, FATME
Entity Type:Individual
Prefix:
First Name:FATME
Middle Name:
Last Name:BOUKHEIR
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 1:310 SCHEPIS AVE
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-4933
Mailing Address - Country:US
Mailing Address - Phone:201-674-7459
Mailing Address - Fax:
Practice Address - Street 1:310 SCHEPIS AVE
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-4933
Practice Address - Country:US
Practice Address - Phone:201-674-7459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered