Provider Demographics
NPI:1508540006
Name:COMPASSION MEDICAL GROUP PC
Entity Type:Organization
Organization Name:COMPASSION MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-370-4000
Mailing Address - Street 1:110 SQUIRE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2516
Mailing Address - Country:US
Mailing Address - Phone:973-241-5856
Mailing Address - Fax:
Practice Address - Street 1:145 PRESIDENTIAL BLVD STE 1
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522-2173
Practice Address - Country:US
Practice Address - Phone:973-241-5856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care