MEDICARE: MOUKDAD MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1477430239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUKDAD MEDICAL LLC

Provider Business Mailing Address
First Line	:	6725 COLUMBIA AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5696
Country	:	US
Telephone Number	:	201-691-7234
Fax Number	:

Provider Business Practice Location Address
First Line	:	6725 COLUMBIA AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5696
Country	:	US
Telephone Number	:	201-691-7234
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMANDA MARCHIONE
Credential	:	DO
Telephone Number	:	347-856-9527

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	09/09/2025

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