Provider Demographics
NPI:1699834747
Name:BEJJANI, FADI JOSEPH (MD PHD)
Entity Type:Individual
Prefix:
First Name:FADI
Middle Name:JOSEPH
Last Name:BEJJANI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2328
Mailing Address - Country:US
Mailing Address - Phone:315-797-1340
Mailing Address - Fax:315-797-2403
Practice Address - Street 1:100 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2328
Practice Address - Country:US
Practice Address - Phone:315-797-1340
Practice Address - Fax:315-797-2403
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1769442081P2900X
NJ501172081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD93291Medicare UPIN
NJ52098Medicare UPIN
AA1546Medicare ID - Type Unspecified
NYRB8168Medicare PIN