Provider Demographics
NPI:1003969387
Name:DIAB, GAMAL M (MD)
Entity Type:Individual
Prefix:DR
First Name:GAMAL
Middle Name:M
Last Name:DIAB
Suffix:
Gender:M
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:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-0569
Mailing Address - Country:US
Mailing Address - Phone:973-219-2532
Mailing Address - Fax:973-541-9103
Practice Address - Street 1:40 BALDWIN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2986
Practice Address - Country:US
Practice Address - Phone:973-541-9101
Practice Address - Fax:973-541-9103
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA47466207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0424005Medicaid
NJ070094OtherMEDICARE GROUP
NJD73195Medicare UPIN
NJ596051A01Medicare PIN
NJ070094OtherMEDICARE GROUP