Provider Demographics
NPI:1689666257
Name:GADALLA, HISHAM H (MD)
Entity Type:Individual
Prefix:DR
First Name:HISHAM
Middle Name:H
Last Name:GADALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 OLD WAGON RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1626
Mailing Address - Country:US
Mailing Address - Phone:973-928-3388
Mailing Address - Fax:973-404-8525
Practice Address - Street 1:1135 MAIN AVE FL 2
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2353
Practice Address - Country:US
Practice Address - Phone:973-928-3388
Practice Address - Fax:973-928-3388
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07589300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0008265Medicaid
NJ084225Medicare ID - Type Unspecified
NJ0008265Medicaid