Provider Demographics
NPI:1477564425
Name:MAROUN, VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:MAROUN
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 1:182 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2602
Mailing Address - Country:US
Mailing Address - Phone:973-754-2240
Mailing Address - Fax:973-754-2249
Practice Address - Street 1:703 MAIN ST
Practice Address - Street 2:SJRMC EMERGENCY DEPARTMENT
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2240
Practice Address - Fax:973-754-2249
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08033300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0109916Medicaid
NJD0884470OtherCDS NUMBER
NJD0884470OtherCDS NUMBER
NJ111526Medicare PIN
P00413579Medicare PIN