Healthcare Provider Details

I. General information

NPI: 1427027200
Provider Name (Legal Business Name): HANY A SOURIAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
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 TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06728600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC186872
License Number StateCA

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:
Title or Position:
Credential:
Phone: