Provider Demographics
NPI:1588634703
Name:GHUSSON, SOHEIR (MD)
Entity Type:Individual
Prefix:
First Name:SOHEIR
Middle Name:
Last Name:GHUSSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690
Mailing Address - Country:US
Mailing Address - Phone:609-584-7771
Mailing Address - Fax:609-584-5520
Practice Address - Street 1:2073 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690
Practice Address - Country:US
Practice Address - Phone:609-584-7771
Practice Address - Fax:609-584-5520
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05096500207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-3476799OtherTAX ID
NJ9075402Medicaid
F91370Medicare UPIN
NJ22-3476799OtherTAX ID