Provider Demographics
NPI:1801082136
Name:J S MOUKDAD MD LLC
Entity type:Organization
Organization Name:J S MOUKDAD MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIHAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOUKDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-223-1121
Mailing Address - Street 1:1265 PATERSON PLANK RD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3242
Mailing Address - Country:US
Mailing Address - Phone:201-223-1121
Mailing Address - Fax:201-223-1126
Practice Address - Street 1:1265 PATERSON PLANK RD
Practice Address - Street 2:SUITE 3 B
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3242
Practice Address - Country:US
Practice Address - Phone:201-223-1121
Practice Address - Fax:201-223-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF88740Medicare UPIN