Provider Demographics
NPI:1134149909
Name:ACKAD, VIVIANE (MD)
Entity type:Individual
Prefix:DR
First Name:VIVIANE
Middle Name:
Last Name:ACKAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE A2
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2405
Mailing Address - Country:US
Mailing Address - Phone:973-497-2424
Mailing Address - Fax:973-497-2448
Practice Address - Street 1:337 BLOOMFIELD AVE
Practice Address - Street 2:APARTMENT A-2
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2405
Practice Address - Country:US
Practice Address - Phone:973-497-2424
Practice Address - Fax:973-497-2448
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH13285Medicare UPIN