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General NPI Number Information
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NPI Number | 1891872412
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Entity Type | Organization
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Legal Business Name | FAYEZ SHAMOON
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 11/03/2008
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Provider Practice Location Address
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Address Line | 268 MARTIN LUTHER KING JR BLVD
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City | NEWARK
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State | NJ
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Zip | 07102-2011
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Country | US
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Telephone | 973-877-5160
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 318
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City | CEDAR GROVE
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State | NJ
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Zip | 07009-0318
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Country | US
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Telephone | 973-877-5160
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FAYEZ SHAMOON
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Credential | MD
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Telephone | 973-877-5160
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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 | 25MA05551600
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License Number State | NJ
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