1568556512 NPI number — RIYADH S HAMMOD MD

Table of content: RIYADH S HAMMOD MD (NPI 1568556512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568556512 NPI number — RIYADH S HAMMOD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMMOD
Provider First Name:
RIYADH
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1568556512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 183
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08302-0137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-451-9395
Provider Business Mailing Address Fax Number:
856-451-8615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1103 W SHERMAN AVE
Provider Second Line Business Practice Location Address:
BLDG 2 UNIT A
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360-6915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-692-9900
Provider Business Practice Location Address Fax Number:
856-692-9911
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  MA067470 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 875240101 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com