Healthcare Provider Details

I. General information

NPI: 1194738708
Provider Name (Legal Business Name): MAGED MOUSSA GERGES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CLARA MAASS DRIVE
BELLEVILLE NJ
07109
US

IV. Provider business mailing address

1305 WALT WHITMAN RD STE 300
MELVILLE NY
11747-4300
US

V. Phone/Fax

Practice location:
  • Phone: 908-653-9399
  • Fax: 908-853-9305
Mailing address:
  • Phone: 516-945-3000
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA07378500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number223515
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: