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General NPI Number Information
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NPI Number | 1427257583
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Entity Type | Organization
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Legal Business Name | M M MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 03/21/2008
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Provider Practice Location Address
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Address Line | 29 MOUNTAIN AVE
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City | HAWTHORNE
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State | NJ
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Zip | 07506-3309
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Country | US
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Telephone | 973-458-0114
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Fax | 973-458-0661
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Provider Business Mailing Address
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Address Line | PO BOX 1217
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City | CLIFTON
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State | NJ
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Zip | 07012-0717
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Country | US
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Telephone | 973-458-0114
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Fax | 973-458-0661
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Authorized Official
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Title or Position | OWNER
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Name | MOURAD ISMAIL
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Credential | MD
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Telephone | 973-458-0114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA07839900
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License Number State | NJ
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