Provider Demographics
NPI:1770696841
Name:MIKHAIL, FAYEZ (MD)
Entity type:Individual
Prefix:
First Name:FAYEZ
Middle Name:
Last Name:MIKHAIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-1014
Mailing Address - Country:US
Mailing Address - Phone:609-587-1001
Mailing Address - Fax:609-587-0227
Practice Address - Street 1:23 MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08088-1014
Practice Address - Country:US
Practice Address - Phone:609-587-1001
Practice Address - Fax:609-587-0227
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA47865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110027952OtherRAIL ROAD MEDICARE
NJ0533633OtherUS HEALTHCARE
NJ83916OtherAMERICAID
NJ9100008422OtherAMERICHOICE
NJ0K0104OtherHEALTHNET
NJ222873394OtherTAX ID
NJ3594106Medicaid
NJ1024394OtherMERCY
NJ0212428000OtherAMERIHEALTH
NJ1024394OtherMERCY
NJ83916OtherAMERICAID