Provider Demographics
NPI:1467511238
Name:GIRGIS FAMILY PRACTICE
Entity type:Organization
Organization Name:GIRGIS FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORIS
Authorized Official - Middle Name:BEACHAY
Authorized Official - Last Name:GIRGIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-254-9494
Mailing Address - Street 1:PO BOX 6779
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-6779
Mailing Address - Country:US
Mailing Address - Phone:732-254-9494
Mailing Address - Fax:732-254-9903
Practice Address - Street 1:171 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-1500
Practice Address - Country:US
Practice Address - Phone:732-254-9494
Practice Address - Fax:732-254-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0126314Medicaid
NJ0126314Medicaid