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General NPI Number Information
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NPI Number | 1659529246
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERAD MEDICAL GROUP,LLC
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | E5 BRIER HILL CT
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3336
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Country | US
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Telephone | 732-698-1331
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Fax |
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Provider Business Mailing Address
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Address Line | E5 BRIER HILL CT
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3336
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Country | US
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Telephone | 732-698-1331
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MOHEB ABDELMALEK
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Credential |
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Telephone | 732-698-1331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MA60096
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License Number State | NJ
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