Provider Demographics
NPI:1366655581
Name:NADER K. MISHREKI,MD,MPH,FAAP
Entity Type:Organization
Organization Name:NADER K. MISHREKI,MD,MPH,FAAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:KAMEEL
Authorized Official - Last Name:MISHREKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-437-8007
Mailing Address - Street 1:74 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2829
Mailing Address - Country:US
Mailing Address - Phone:201-437-8007
Mailing Address - Fax:201-437-8003
Practice Address - Street 1:74 W 35TH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2829
Practice Address - Country:US
Practice Address - Phone:201-437-8007
Practice Address - Fax:201-437-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8025703Medicaid
NJ8025703Medicaid