Provider Demographics
NPI:1356992440
Name:FATEMA, KANIZ
Entity type:Individual
Prefix:
First Name:KANIZ
Middle Name:
Last Name:FATEMA
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 1:6800 JERICHO TURNPIKE
Mailing Address - Street 2:STE 120W
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-393-5966
Mailing Address - Fax:
Practice Address - Street 1:6800 JERICHO TURNPIKE
Practice Address - Street 2:STE 120W
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:516-393-5966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator