Provider Demographics
NPI:1659529246
Name:GOOD SHEPHERAD MEDICAL GROUP,LLC
Entity Type:Organization
Organization Name:GOOD SHEPHERAD MEDICAL GROUP,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHEB
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELMALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-698-1331
Mailing Address - Street 1:E5 BRIER HILL CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3336
Mailing Address - Country:US
Mailing Address - Phone:732-698-1331
Mailing Address - Fax:
Practice Address - Street 1:E5 BRIER HILL CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3336
Practice Address - Country:US
Practice Address - Phone:732-698-1331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60096207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ058080Medicare UPIN
058080Medicare PIN