Provider Demographics
NPI:1346296811
Name:HANY A SOURIAL MD PC
Entity Type:Organization
Organization Name:HANY A SOURIAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOURIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-265-1818
Mailing Address - Street 1:39 MEADOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2504
Mailing Address - Country:US
Mailing Address - Phone:201-265-1818
Mailing Address - Fax:201-897-5430
Practice Address - Street 1:1 SEARS DR FL 3
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3515
Practice Address - Country:US
Practice Address - Phone:201-265-1818
Practice Address - Fax:201-897-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8718105Medicaid
NJ138781Medicare PIN
NJ8718105Medicaid