Provider Demographics
NPI:1760424378
Name:HANNALLAH, YOUSSEF A (MD)
Entity Type:Individual
Prefix:
First Name:YOUSSEF
Middle Name:A
Last Name:HANNALLAH
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 1:211 DARWIN AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1306
Mailing Address - Country:US
Mailing Address - Phone:201-330-3335
Mailing Address - Fax:201-330-3326
Practice Address - Street 1:255 ROUTE 3 EAST
Practice Address - Street 2:SUITE 107
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3857
Practice Address - Country:US
Practice Address - Phone:201-330-3335
Practice Address - Fax:201-330-3326
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2008-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06231700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6956700Medicaid
NJ875357Medicare PIN