Provider Demographics
NPI:1154439610
Name:HAMZA, HISHAM MOHAMED (MD)
Entity Type:Individual
Prefix:
First Name:HISHAM
Middle Name:MOHAMED
Last Name:HAMZA
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 1:196 EDGEMERE CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-0933
Mailing Address - Country:US
Mailing Address - Phone:732-914-0477
Mailing Address - Fax:
Practice Address - Street 1:558 COMMONS WAY
Practice Address - Street 2:BUILDING E
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6432
Practice Address - Country:US
Practice Address - Phone:732-736-0110
Practice Address - Fax:732-736-0990
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07144300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8352909Medicaid
NJ8352909Medicaid
NJ043529Medicare ID - Type Unspecified