Provider Demographics
NPI:1740592310
Name:JANEM, WALEED FATHI MUSTAFA (MD)
Entity Type:Individual
Prefix:
First Name:WALEED FATHI MUSTAFA
Middle Name:
Last Name:JANEM
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 1:155 MERILINE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3054
Mailing Address - Country:US
Mailing Address - Phone:201-321-4512
Mailing Address - Fax:
Practice Address - Street 1:155 MERILINE AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-3054
Practice Address - Country:US
Practice Address - Phone:201-321-4512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-11
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program