Healthcare Provider Details

I. General information

NPI: 1083175830
Provider Name (Legal Business Name): LAMA RAED NOUREDDINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST PH 16
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

464 HOBSON AVE FL 1
SADDLE BROOK NJ
07663-5908
US

V. Phone/Fax

Practice location:
  • Phone: 201-256-7021
  • Fax:
Mailing address:
  • Phone: 201-256-7021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number345239
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: