Healthcare Provider Details

I. General information

NPI: 1154725760
Provider Name (Legal Business Name): GLOBAL TRAVEL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2014
Last Update Date: 10/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 ISLAND RD SUITE 2B
RAMSEY NJ
07446-2813
US

IV. Provider business mailing address

545 ISLAND RD SUITE 2B
RAMSEY NJ
07446-2813
US

V. Phone/Fax

Practice location:
  • Phone: 201-253-8470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number25MA08858500
License Number StateNJ

VIII. Authorized Official

Name: DR. RAFIK HANNA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 201-253-8470