Provider Demographics
NPI:1184760811
Name:HANNOUSH, PETER YOUSEF (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:YOUSEF
Last Name:HANNOUSH
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 1:380 SUTTON AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1829
Mailing Address - Country:US
Mailing Address - Phone:201-488-8766
Mailing Address - Fax:201-488-8646
Practice Address - Street 1:380 SUTTON AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1829
Practice Address - Country:US
Practice Address - Phone:201-488-8766
Practice Address - Fax:201-488-8646
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA65456207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7331100Medicaid
NJ959508Medicare ID - Type Unspecified
NJG56024Medicare UPIN