Provider Demographics
NPI:1750023230
Name:FAYYAZ, AHMED (OT)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:FAYYAZ
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 JEFFREY LN
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8717
Mailing Address - Country:US
Mailing Address - Phone:908-613-2552
Mailing Address - Fax:
Practice Address - Street 1:620 JEFFREY LN
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-8717
Practice Address - Country:US
Practice Address - Phone:908-613-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00843700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty