Provider Demographics
NPI:1871176453
Name:MUHAMMAD USMAN BIN FAHIM, FNU (MD)
Entity type:Individual
Prefix:MR
First Name:FNU
Middle Name:
Last Name:MUHAMMAD USMAN BIN FAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:USMAN
Other - Middle Name:
Other - Last Name:FAHIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:75 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2119
Mailing Address - Country:US
Mailing Address - Phone:631-686-1443
Mailing Address - Fax:631-686-7651
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL HSC LEVEL 16, ROOM 080E
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-2119
Practice Address - Country:US
Practice Address - Phone:631-444-1617
Practice Address - Fax:631-546-7004
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program