Provider Demographics
NPI:1447241567
Name:FETEIHA, MUHAMMAD S (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:S
Last Name:FETEIHA
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 1:155 MORRIS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1225
Mailing Address - Country:US
Mailing Address - Phone:973-232-2300
Mailing Address - Fax:973-232-2301
Practice Address - Street 1:155 MORRIS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1225
Practice Address - Country:US
Practice Address - Phone:973-232-2300
Practice Address - Fax:973-232-2301
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ72660208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8636001Medicaid
NJ8636001Medicaid
NJ051178S8MMedicare ID - Type Unspecified