1871176453 NPI number — MR. FNU MUHAMMAD USMAN BIN FAHIM MD

Table of content: MR. FNU MUHAMMAD USMAN BIN FAHIM MD (NPI 1871176453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871176453 NPI number — MR. FNU MUHAMMAD USMAN BIN FAHIM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUHAMMAD USMAN BIN FAHIM
Provider First Name:
FNU
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FAHIM
Provider Other First Name:
USMAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871176453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 N COUNTRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT JEFFERSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11777-2119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-686-1443
Provider Business Mailing Address Fax Number:
631-686-7651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STONY BROOK UNIVERSITY HOSPITAL HSC LEVEL 16, ROOM 080E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794-2119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-1617
Provider Business Practice Location Address Fax Number:
631-546-7004
Provider Enumeration Date:
05/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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