Provider Demographics
NPI:1447809819
Name:BAHARY, FATIMA (RDN)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:BAHARY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 CENTENNIAL AVE
Mailing Address - Street 2:SUITE 5, MBN 159
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854
Mailing Address - Country:US
Mailing Address - Phone:732-659-4876
Mailing Address - Fax:
Practice Address - Street 1:5702 HANA RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2571
Practice Address - Country:US
Practice Address - Phone:908-787-7802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered