Provider Demographics
NPI:1740635804
Name:MOUALLEM, JOSEPH P (MD, JD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:MOUALLEM
Suffix:
Gender:M
Credentials:MD, JD
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Mailing Address - Street 1:135 AMITY ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6115
Mailing Address - Country:US
Mailing Address - Phone:212-757-7732
Mailing Address - Fax:646-354-7629
Practice Address - Street 1:26 COURT ST STE 2125
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1136
Practice Address - Country:US
Practice Address - Phone:212-757-7732
Practice Address - Fax:646-354-7629
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2024-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2942312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6372780OtherAETNA STUDENT HEALTH