Provider Demographics
NPI:1831106558
Name:KAMAL GREISS MD PA
Entity Type:Organization
Organization Name:KAMAL GREISS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GREISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-451-1441
Mailing Address - Street 1:148 BREWSTER RD
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2156
Mailing Address - Country:US
Mailing Address - Phone:201-451-1441
Mailing Address - Fax:201-451-1088
Practice Address - Street 1:75 MONTGOMERY STREET
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-451-1441
Practice Address - Fax:201-451-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJFACILITY80238207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2893207Medicaid
1013442OtherHORIZON NJ HEALTH
0788531000OtherAMERIHEALTH GROUP
0788531000OtherAMERIHEALTH GROUP
1013442OtherHORIZON NJ HEALTH