Provider Demographics
NPI:1134504228
Name:DR REGO PC
Entity Type:Organization
Organization Name:DR REGO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-650-2009
Mailing Address - Street 1:705 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2098
Mailing Address - Country:US
Mailing Address - Phone:973-650-2009
Mailing Address - Fax:253-650-2009
Practice Address - Street 1:705 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2098
Practice Address - Country:US
Practice Address - Phone:973-650-2009
Practice Address - Fax:253-650-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF33433Medicare UPIN
NJ046928Medicare Oscar/Certification