Provider Demographics
NPI: | 1619017589 |
---|---|
Name: | MARWAN ASSALEH, MD, PC |
Entity Type: | Organization |
Organization Name: | MARWAN ASSALEH, MD, PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARWAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ASSALEH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 201-653-9115 |
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: | |
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: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-02-08 |
Last Update Date: | 2007-09-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 25MA05278500 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty |