Provider Demographics
NPI:1821067786
Name:AQEL, MAHMOUD (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:
Last Name:AQEL
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 1:355 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-3642
Mailing Address - Country:US
Mailing Address - Phone:973-523-9090
Mailing Address - Fax:973-523-5222
Practice Address - Street 1:355 21ST AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-3642
Practice Address - Country:US
Practice Address - Phone:973-523-9090
Practice Address - Fax:973-523-5222
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6849709Medicaid
NJG53477Medicare UPIN
NJ022964Medicare ID - Type Unspecified