Provider Demographics
NPI:1578637260
Name:HESSEIN, AMGAD ALY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMGAD
Middle Name:ALY
Last Name:HESSEIN
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 1:24 DOGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:973-877-5181
Mailing Address - Fax:973-877-2744
Practice Address - Street 1:268 ML KING BLVD
Practice Address - Street 2:ST MICHAELS HOSPITAL
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-877-5181
Practice Address - Fax:973-877-2744
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67650208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7844204Medicaid
NJ023885Medicare ID - Type Unspecified
F37270Medicare UPIN