Provider Demographics
NPI:1144317439
Name:FAHMY, SANDRA (DO)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:FAHMY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48270
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4800
Mailing Address - Country:US
Mailing Address - Phone:201-818-9118
Mailing Address - Fax:
Practice Address - Street 1:2433 COUNTY HIGHWAY 516
Practice Address - Street 2:SUITE 3B
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857
Practice Address - Country:US
Practice Address - Phone:732-360-0287
Practice Address - Fax:732-360-1279
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07898500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2835304000OtherAMERIHEALTH #
NJ1454681OtherAETNA HMO #
NJ3K5104OtherHEALTHNET #
NJ6D0891OtherEMPIRE BCBS #
NJ7314878OtherAETNA PPO #
NJP00381706OtherRR MDCR #
NJP3720931OtherOXFORD #
NJ6D0891OtherEMPIRE BCBS #
NJ7314878OtherAETNA PPO #