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General NPI Number Information
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NPI Number | 1255434312
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Entity Type | Individual
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Provider Name | MANAL ANN SOUS MD
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 637 WYCOFF AVE SECOND FLOOR OFFICE 3
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City | WYCKOFF
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State | NJ
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Zip | 07481
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Country | US
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Telephone | 201-848-0700
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Fax | 201-848-0677
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Provider Business Mailing Address
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Address Line | 637 WYCOFF AVE SECOND FLOOR OFFICE 3
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City | WYCKOFF
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State | NJ
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Zip | 07481
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Country | US
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Telephone | 201-848-0700
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Fax | 201-848-0677
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MA66503
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License Number State | NJ
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