=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609299254
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEWTON PEDIATRIC HOSPITALISTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2014
-----------------------------------------------------
Last Update Date | 01/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 290 UNION BLVD STE 2
-----------------------------------------------------
City | TOTOWA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07512-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-452-1243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 290 UNION BLVD STE 2
-----------------------------------------------------
City | TOTOWA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07512-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | YOUSEF ABDULMASIH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-452-1243
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MA62512
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------