Provider Demographics
NPI:1952391054
Name:FAHMY, ADHAM HUSSEIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADHAM
Middle Name:HUSSEIN
Last Name:FAHMY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 MAIN ST
Mailing Address - Street 2:APT # B
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5103
Mailing Address - Country:US
Mailing Address - Phone:917-586-4051
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-241-7215
Practice Address - Fax:212-534-7491
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY459981223G0001X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02384861Medicaid
NY02384861Medicaid
NYA400007920Medicare PIN