Provider Demographics
NPI:1770927816
Name:ABDALLA, FATHY SHARAF (PHD, NCPSYA)
Entity type:Individual
Prefix:DR
First Name:FATHY
Middle Name:SHARAF
Last Name:ABDALLA
Suffix:
Gender:M
Credentials:PHD, NCPSYA
Other - Prefix:PROF
Other - First Name:FATHY
Other - Middle Name:M
Other - Last Name:ABDALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, NCPSYA
Mailing Address - Street 1:121 CEDAR LN
Mailing Address - Street 2:SUITE 3-B
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4457
Mailing Address - Country:US
Mailing Address - Phone:862-812-0647
Mailing Address - Fax:201-836-3902
Practice Address - Street 1:121 CEDAR LN
Practice Address - Street 2:SUITE 3-B
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4457
Practice Address - Country:US
Practice Address - Phone:862-812-0647
Practice Address - Fax:201-836-3902
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT098.0090538102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst