Healthcare Provider Details

I. General information

NPI: 1063612059
Provider Name (Legal Business Name): DR. MARINA HAGHOUR-VWICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. MARINA MOH'D HAGHOUR

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652-4142
US

IV. Provider business mailing address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652-4142
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-4000
  • Fax:
Mailing address:
  • Phone: 201-967-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0237736
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: