Healthcare Provider Details

I. General information

NPI: 1033475249
Provider Name (Legal Business Name): MARIAM GAMAL WASSEF D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 11/02/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 ROUTE 35
EATONTOWN NJ
07724
US

IV. Provider business mailing address

74 BRUNSWICK WOODS DR
EAST BRUNSWICK NJ
08816-5601
US

V. Phone/Fax

Practice location:
  • Phone: 732-440-7336
  • Fax: 732-440-9404
Mailing address:
  • Phone: 732-947-8084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number25MB09660600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: