Healthcare Provider Details

I. General information

NPI: 1487728291
Provider Name (Legal Business Name): MAJD LOULOU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER WAY FL 4
SOMERS POINT NJ
08244-2300
US

IV. Provider business mailing address

396 BROADWAY MID HUDSON PHYSICIANS, PC
KINGSTON NY
12401-4626
US

V. Phone/Fax

Practice location:
  • Phone: 609-365-6200
  • Fax: 609-926-4311
Mailing address:
  • Phone: 845-331-3131
  • Fax: 845-334-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number242168
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA08542700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: