Provider Demographics
NPI:1407181852
Name:HILAL MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:HILAL MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOUSHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-748-5700
Mailing Address - Street 1:194 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2606
Mailing Address - Country:US
Mailing Address - Phone:973-484-5887
Mailing Address - Fax:973-484-9740
Practice Address - Street 1:482 N 12TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1312
Practice Address - Country:US
Practice Address - Phone:973-484-5887
Practice Address - Fax:973-484-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06156600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6761607Medicaid
NJ729628Medicare PIN