Healthcare Provider Details

I. General information

NPI: 1851390470
Provider Name (Legal Business Name): MARWAN F HAMMOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N WASHINGTON AVE
GREEN BROOK NJ
08812-2619
US

IV. Provider business mailing address

1005 N WASHINGTON AVE PO BOX 890
GREEN BROOK NJ
08812-2619
US

V. Phone/Fax

Practice location:
  • Phone: 732-968-8900
  • Fax: 732-968-4898
Mailing address:
  • Phone: 732-968-8900
  • Fax: 732-968-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA08440400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number233296
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: