Provider Demographics
NPI:1629155429
Name:INFECTIOUS DISEASE CENTER OF NEW JERSEY, LLC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE CENTER OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANAL
Authorized Official - Middle Name:FAROUK
Authorized Official - Last Name:YOUSSEF-BESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-535-8355
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-0273
Mailing Address - Country:US
Mailing Address - Phone:973-535-8355
Mailing Address - Fax:973-535-8353
Practice Address - Street 1:568 ROUTE 10 W
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1516
Practice Address - Country:US
Practice Address - Phone:973-535-8355
Practice Address - Fax:973-535-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07758200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI51067Medicare UPIN
NJ104302Medicare PIN