Provider Demographics
NPI:1598004111
Name:MARWA MOUSSA PHYSICIAN PC
Entity Type:Organization
Organization Name:MARWA MOUSSA PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARWA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-605-5133
Mailing Address - Street 1:22 PUTTERS CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3368
Mailing Address - Country:US
Mailing Address - Phone:917-605-5133
Mailing Address - Fax:718-682-1059
Practice Address - Street 1:22 PUTTERS CT
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3368
Practice Address - Country:US
Practice Address - Phone:917-605-5133
Practice Address - Fax:718-682-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty