Provider Demographics
NPI:1053494625
Name:GHANEM, SIHAM TAFTAF (MD)
Entity Type:Individual
Prefix:
First Name:SIHAM
Middle Name:TAFTAF
Last Name:GHANEM
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 1:91 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1026
Mailing Address - Country:US
Mailing Address - Phone:973-278-9600
Mailing Address - Fax:973-278-9600
Practice Address - Street 1:91 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1026
Practice Address - Country:US
Practice Address - Phone:973-278-9600
Practice Address - Fax:973-278-9600
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02943000208000000X, 261QM2500X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2011204Medicaid