Provider Demographics
NPI:1114945888
Name:TANTAWI, MOHAMED ASEM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:ASEM
Last Name:TANTAWI
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 1:177 SUMMIT AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1311
Mailing Address - Country:US
Mailing Address - Phone:201-487-6487
Mailing Address - Fax:201-487-2126
Practice Address - Street 1:177 SUMMIT AVE
Practice Address - Street 2:HACKENSACK PEDIATRICS
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1311
Practice Address - Country:US
Practice Address - Phone:201-487-8222
Practice Address - Fax:201-487-2126
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA76601208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics