Healthcare Provider Details

I. General information

NPI: 1568556512
Provider Name (Legal Business Name): RIYADH S HAMMOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 W SHERMAN AVE BLDG 2 UNIT A
VINELAND NJ
08360-6915
US

IV. Provider business mailing address

PO BOX 183
BRIDGETON NJ
08302-0137
US

V. Phone/Fax

Practice location:
  • Phone: 856-692-9900
  • Fax: 856-692-9911
Mailing address:
  • Phone: 856-451-9395
  • Fax: 856-451-8615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMA067470
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: