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NPI Code Detail

MEDICARE: BASSAM M HADDAD M.D

MEDICARE: BASSAM M HADDAD M.D
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
1174400000XSpecialistMA03243600NJ
2207RN0300XNephrology PhysicianMA03243600NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790784510
Entity Type Code : Individual
Provider Name (Legal Business Name) : BASSAM M HADDAD M.D
Provider Business Mailing Address
First Line : 26 GREENVILLE AVE
Second Line :
City : JERSEY CITY
State : NJ
Zip : 07305-2608
Country : US
Telephone Number : 201-333-8222
Fax Number : 201-333-0095
Provider Business Practice Location Address
First Line : 26 GREENVILLE AVE
Second Line :
City : JERSEY CITY
State : NJ
Zip : 07305-2608
Country : US
Telephone Number : 201-333-8222
Fax Number : 201-333-0095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 05/08/2024

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