Healthcare Provider Details

I. General information

NPI: 1366655581
Provider Name (Legal Business Name): NADER K. MISHREKI,MD,MPH,FAAP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 W 35TH ST
BAYONNE NJ
07002-2829
US

IV. Provider business mailing address

74 W 35TH ST
BAYONNE NJ
07002-2829
US

V. Phone/Fax

Practice location:
  • Phone: 201-437-8007
  • Fax: 201-437-8003
Mailing address:
  • Phone: 201-437-8007
  • Fax: 201-437-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NADER KAMEEL MISHREKI
Title or Position: OWNER
Credential: MD
Phone: 201-437-8007