Provider Demographics
NPI:1790784510
Name:HADDAD, BASSAM M (MD)
Entity Type:Individual
Prefix:
First Name:BASSAM
Middle Name:M
Last Name:HADDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26 GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2608
Mailing Address - Country:US
Mailing Address - Phone:201-333-8222
Mailing Address - Fax:201-333-0095
Practice Address - Street 1:26 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2608
Practice Address - Country:US
Practice Address - Phone:201-333-8222
Practice Address - Fax:201-333-0095
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA03243600174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3023702Medicaid