Healthcare Provider Details

I. General information

NPI: 1215786447
Provider Name (Legal Business Name): HISHAM HASHISH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 WESTWOOD DR STE 103
WEST DEPTFORD NJ
08096-3144
US

IV. Provider business mailing address

1092 CHEWS LANDING RD
CLEMENTON NJ
08021-2958
US

V. Phone/Fax

Practice location:
  • Phone: 856-249-8513
  • Fax: 856-994-1018
Mailing address:
  • Phone: 856-249-8513
  • Fax: 856-994-1018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. HISHAM A A HASHISH
Title or Position: OWNER
Credential: MD
Phone: 856-249-8513