Healthcare Provider Details

I. General information

NPI: 1285718817
Provider Name (Legal Business Name): HISHAM HASHISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CENTRAL AVE
MIDLAND PARK NJ
07432-1401
US

IV. Provider business mailing address

33 CENTRAL AVE
MIDLAND PARK NJ
07432-1401
US

V. Phone/Fax

Practice location:
  • Phone: 201-848-8000
  • Fax: 201-625-6464
Mailing address:
  • Phone: 201-848-8000
  • Fax: 201-625-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA08688500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD2008-0633
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMA08688500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: