Provider Demographics
NPI:1295727758
Name:HMOUD, TALAT Y (MD)
Entity type:Individual
Prefix:DR
First Name:TALAT
Middle Name:Y
Last Name:HMOUD
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 1:66 W GILBERT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:732-212-0060
Mailing Address - Fax:732-212-0061
Practice Address - Street 1:155 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1706
Practice Address - Country:US
Practice Address - Phone:973-589-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06150500207P00000X, 207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7061200Medicaid
NJ91001494200OtherAMERICHOICE
NJ778209P7GMedicare PIN
NJ778209MK3Medicare PIN
NJ778209UWYMedicare PIN
NJ778209DLEMedicare PIN
NJG06507Medicare UPIN
NJ778209DPHMedicare PIN
NJ91001494200OtherAMERICHOICE
NJ778209Medicare ID - Type Unspecified