Provider Demographics
NPI:1043961139
Name:FAY, PASHA (LMT)
Entity type:Individual
Prefix:
First Name:PASHA
Middle Name:
Last Name:FAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 ORCHARD ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3174
Mailing Address - Country:US
Mailing Address - Phone:516-642-8748
Mailing Address - Fax:
Practice Address - Street 1:1147 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3103
Practice Address - Country:US
Practice Address - Phone:631-402-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032376146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032276Medicaid
NYALA72827W01Medicaid