Healthcare Provider Details

I. General information

NPI: 1275974784
Provider Name (Legal Business Name): ANDREW HADDAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 601
HACKENSACK NJ
07601-1962
US

IV. Provider business mailing address

20 PROSPECT AVE STE 601
HACKENSACK NJ
07601-1962
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2765
  • Fax: 201-487-8516
Mailing address:
  • Phone: 551-996-2765
  • Fax: 202-509-9312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberMD044765
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD044765
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number25MA11201000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: