Provider Demographics
NPI:1073523742
Name:AKROUT, TARAK (MD)
Entity Type:Individual
Prefix:
First Name:TARAK
Middle Name:
Last Name:AKROUT
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 35
Mailing Address - Street 2:270 SOUTH BROADWAY
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070
Mailing Address - Country:US
Mailing Address - Phone:856-678-5449
Mailing Address - Fax:856-678-3153
Practice Address - Street 1:270 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070
Practice Address - Country:US
Practice Address - Phone:856-678-5449
Practice Address - Fax:856-678-3153
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04603600208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5627800Medicaid
260026364OtherRAILROAD MEDICARE
C63296Medicare UPIN
NJ5627800Medicaid