Provider Demographics
NPI:1750394391
Name:FAZAL, RABEENA (MD)
Entity type:Individual
Prefix:
First Name:RABEENA
Middle Name:
Last Name:FAZAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13405 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3020
Mailing Address - Country:US
Mailing Address - Phone:718-323-9700
Mailing Address - Fax:718-323-0300
Practice Address - Street 1:13405 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3020
Practice Address - Country:US
Practice Address - Phone:718-323-9700
Practice Address - Fax:718-323-0300
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237316207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02709222Medicaid
NY02709222Medicaid
07460Medicare ID - Type Unspecified
0855V1Medicare ID - Type Unspecified