Healthcare Provider Details

I. General information

NPI: 1083872154
Provider Name (Legal Business Name): HANNY S MABROUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 HOES LN W RM C-205
PISCATAWAY NJ
08854-8021
US

IV. Provider business mailing address

5 FLINTLOCK CT
BASKING RIDGE NJ
07920-2107
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-4040
  • Fax:
Mailing address:
  • Phone: 908-630-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number25MA08339800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: