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General NPI Number Information
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NPI Number | 1629092218
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Entity Type | Individual
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Provider Name | ISSAM MOUDED M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 255 STATE RT 3 SUITE#105
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City | SECAUCUS
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State | NJ
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Zip | 07094-3857
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Country | US
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Telephone | 201-865-1919
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Fax | 201-865-4022
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Provider Business Mailing Address
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Address Line | 255 STATE RT 3 SUITE#105
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City | SECAUCUS
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State | NJ
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Zip | 07094-3857
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Country | US
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Telephone | 201-865-1919
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Fax | 201-865-4022
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MA39766
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License Number State | NJ
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