1760541312 NPI number — MOHAMED KAWAM M.D.

Table of content: MOHAMED KAWAM M.D. (NPI 1760541312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760541312 NPI number — MOHAMED KAWAM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAWAM
Provider First Name:
MOHAMED
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1760541312
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07474-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-942-3200
Provider Business Mailing Address Fax Number:
973-942-2901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 HALEDON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSPECT PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07508-2051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-942-3200
Provider Business Practice Location Address Fax Number:
973-942-2901
Provider Enumeration Date:
12/08/2006

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: 174400000X , with the licence number:  25MA06054400 , 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: 0527024 . This is a "AETNA HMO#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K3301 . This is a "HEALTHNET #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000019400 . This is a "AMERICHOICE#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 395AD1 . This is a "EMPIRE BC/BS NY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5503390 . This is a "GHI PPO#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00311542 . This is a "RR MDCR #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4592906 . This is a "AETNA PPO#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1081846 . This is a "HORIZON NJ HEALTH#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0551037000 . This is a "AMERIHEALTH#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 12129 . This is a "UNIVERSITY HEALTH PLANS #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2145955 . This is a "OXFORD#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 12189 . This is a "AMERIGROUP#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223521353 . This is a "TAX ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6274501 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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