Healthcare Provider Details

I. General information

NPI: 1790415370
Provider Name (Legal Business Name): RYAN BASSEL DAOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 WEST SOUTH ORANGE AVE
NEWARK NJ
07103
US

IV. Provider business mailing address

40 BENNETT RD UNIT 439
ENGLEWOOD NJ
07631-3272
US

V. Phone/Fax

Practice location:
  • Phone: 732-445-4636
  • Fax:
Mailing address:
  • Phone: 973-262-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA13202500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: