Healthcare Provider Details

I. General information

NPI: 1346296811
Provider Name (Legal Business Name): HANY A SOURIAL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SEARS DR FL 3
PARAMUS NJ
07652-3515
US

IV. Provider business mailing address

39 MEADOW LAKE DR
MAHWAH NJ
07430-2504
US

V. Phone/Fax

Practice location:
  • Phone: 201-265-1818
  • Fax: 201-897-5430
Mailing address:
  • Phone: 201-265-1818
  • Fax: 201-897-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8718105
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: DR. HANY A SOURIAL
Title or Position: OWNER
Credential: MD
Phone: 201-265-1818