Provider Demographics
NPI:1245442490
Name:ZGHEIB, MOHAMMAD HUSSEIN (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:HUSSEIN
Last Name:ZGHEIB
Suffix:
Gender:
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:PO BOX 61507
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-7507
Mailing Address - Country:US
Mailing Address - Phone:718-761-8800
Mailing Address - Fax:718-761-8804
Practice Address - Street 1:1112 SOUTH AVE STE A
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3410
Practice Address - Country:US
Practice Address - Phone:718-761-8800
Practice Address - Fax:718-761-8804
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257360207RC0000X, 207RI0011X
NJ25MA08580400207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03606948Medicaid
NJ0199541Medicaid
NY03287029Medicaid
NYA100082847OtherMEDICARE
NYA300039314OtherMEDICARE