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General NPI Number Information
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NPI Number | 1609144096
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Entity Type | Organization
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Legal Business Name | MASSAPEQUA MEDICAL PC
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 727 N BROADWAY SUITE A1
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City | MASSAPEQUA
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State | NY
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Zip | 11758-2348
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Country | US
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Telephone | 516-798-8090
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Fax | 516-795-3606
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Provider Business Mailing Address
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Address Line | 727 N BROADWAY SUITE A1
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City | MASSAPEQUA
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State | NY
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Zip | 11758-2348
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Country | US
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Telephone | 516-798-8090
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Fax | 516-795-3606
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARWAN HAMMOUD
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Credential | M.D.
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Telephone | 516-798-8090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 233296
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License Number State | NY
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