Provider Demographics
NPI:1346225885
Name:MANSOUR, ALI GABER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:GABER
Last Name:MANSOUR
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 5881
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08875-5881
Mailing Address - Country:US
Mailing Address - Phone:732-715-7705
Mailing Address - Fax:
Practice Address - Street 1:84 VERONICA AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3529
Practice Address - Country:US
Practice Address - Phone:732-418-1111
Practice Address - Fax:732-418-1120
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07554700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1484071OtherAETNA
NJ205729007Medicaid
6464776OtherCIGNA
6464776OtherCIGNA
NJ205729007Medicaid