Basic Information
Provider Information
NPI: 1003139734
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EL BAHTITY
FirstName: FAWZY
MiddleName: HASSAN
NamePrefix: MR.
NameSuffix:  
Credential: R.PH.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10932 ALEXANDER RD
Address2:  
City: ATTICA
State: NY
PostalCode: 140119420
CountryCode: US
TelephoneNumber: 5855910143
FaxNumber:  
Practice Location
Address1: 91 N MAIN ST
Address2:  
City: WARSAW
State: NY
PostalCode: 145691343
CountryCode: US
TelephoneNumber: 5857862100
FaxNumber: 5857863217
Other Information
ProviderEnumerationDate: 03/09/2010
LastUpdateDate: 03/09/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X028900NYY Pharmacy Service ProvidersPharmacist 

ID Information
IDTypeStateIssuerDescription
188175792001 NATIONAL PROVIDER NUMBER FOR REXALL DRUG INC.OTHER
335521801 NCPDPOTHER
0048548305NY MEDICAID


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