Provider Demographics
NPI:1457759458
Name:MONMOUTH ARTHRITIS & OSTEOPOROSIS, LLC
Entity Type:Organization
Organization Name:MONMOUTH ARTHRITIS & OSTEOPOROSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-414-6001
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-0281
Mailing Address - Country:US
Mailing Address - Phone:732-414-6001
Mailing Address - Fax:732-414-6003
Practice Address - Street 1:219 TAYLORS MILLS RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3255
Practice Address - Country:US
Practice Address - Phone:732-414-6001
Practice Address - Fax:732-414-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08174300207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty