Provider Demographics
NPI:1912403189
Name:FATMI, OMMUL BANEEN ALI (DO)
Entity Type:Individual
Prefix:DR
First Name:OMMUL
Middle Name:BANEEN ALI
Last Name:FATMI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:STONY BROOK CHILDRENS' HOSPITAL - 101 NICOLLS RD
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS - HSC T-11, ROOM 040
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8111
Mailing Address - Country:US
Mailing Address - Phone:631-444-2020
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK CHILDRENS' HOSPITAL - 101 NICOLLS RD
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS - HSC T-11, ROOM 040
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794
Practice Address - Country:US
Practice Address - Phone:631-444-2020
Practice Address - Fax:631-444-2894
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program