1295166973 NPI number — TAREK M MOUSA PHYSICIAN PC

Table of content: (NPI 1295166973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295166973 NPI number — TAREK M MOUSA PHYSICIAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAREK M MOUSA PHYSICIAN PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295166973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1081 PARSIPPANY BLVD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
PARSIPPANY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07054-1291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-784-4663
Provider Business Mailing Address Fax Number:
973-664-0161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
156 ROUTE 59
Provider Second Line Business Practice Location Address:
UNIT B2
Provider Business Practice Location Address City Name:
SUFFERN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10901-5005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-784-4663
Provider Business Practice Location Address Fax Number:
973-664-0161
Provider Enumeration Date:
12/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
NITA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
973-784-4663

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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