Provider Demographics
NPI:1497998561
Name:ABDELFATTAH, HESHAM MAHMOUD (MD)
Entity Type:Individual
Prefix:
First Name:HESHAM
Middle Name:MAHMOUD
Last Name:ABDELFATTAH
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 1:4810 BELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6952
Mailing Address - Country:US
Mailing Address - Phone:732-938-6090
Mailing Address - Fax:732-938-5680
Practice Address - Street 1:4810 BELMAR BLVD
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07753-6952
Practice Address - Country:US
Practice Address - Phone:732-938-6090
Practice Address - Fax:732-938-5680
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-19
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09503100207XS0106X
PAMD451314207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery