Provider Demographics
NPI:1518066000
Name:ASSALEH, MARWAN (MD)
Entity Type:Individual
Prefix:
First Name:MARWAN
Middle Name:
Last Name:ASSALEH
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 1:591 SUMMIT AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2714
Mailing Address - Country:US
Mailing Address - Phone:201-653-9115
Mailing Address - Fax:201-653-8119
Practice Address - Street 1:591 SUMMIT AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2714
Practice Address - Country:US
Practice Address - Phone:201-653-9115
Practice Address - Fax:201-653-8119
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05278500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7903006Medicaid
NJ7903006Medicaid
NJE53159Medicare UPIN