=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982589008
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABANOUB JAD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2025
-----------------------------------------------------
Last Update Date | 08/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 654 WESTWOOD AVE
-----------------------------------------------------
City | RIVER VALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07675-6256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-664-9600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 654 WESTWOOD AVE
-----------------------------------------------------
City | RIVER VALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07675-6256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-715-2044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------