Provider Demographics
NPI:1831264316
Name:MONA M TANTAWI,MD,PC
Entity type:Organization
Organization Name:MONA M TANTAWI,MD,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TANTAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-487-8222
Mailing Address - Street 1:177 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1311
Mailing Address - Country:US
Mailing Address - Phone:201-487-8222
Mailing Address - Fax:207-487-2126
Practice Address - Street 1:177 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1311
Practice Address - Country:US
Practice Address - Phone:201-487-8222
Practice Address - Fax:207-487-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03599800261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health