Provider Demographics
NPI:1295785590
Name:MEAH, FATEMA (MD)
Entity type:Individual
Prefix:
First Name:FATEMA
Middle Name:
Last Name:MEAH
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 1:34 COMMERCE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3118
Mailing Address - Country:US
Mailing Address - Phone:631-722-8880
Mailing Address - Fax:631-722-7850
Practice Address - Street 1:34 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-722-8880
Practice Address - Fax:631-722-8880
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214233208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02234242Medicaid
NY0357AGMedicare ID - Type Unspecified
NY02234242Medicaid