Provider Demographics
NPI:1700128915
Name:FAHIMA, DEWAN KAZI
Entity Type:Individual
Prefix:DR
First Name:DEWAN
Middle Name:KAZI
Last Name:FAHIMA
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 1:1415 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3521
Mailing Address - Country:US
Mailing Address - Phone:201-837-7788
Mailing Address - Fax:
Practice Address - Street 1:1415 QUEEN ANNE RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3521
Practice Address - Country:US
Practice Address - Phone:201-837-7788
Practice Address - Fax:201-837-2077
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10466600207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology