Provider Demographics
NPI:1063612059
Name:HAGHOUR-VWICH, MARINA
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:HAGHOUR-VWICH
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MARINA
Other - Middle Name:MOH'D
Other - Last Name:HAGHOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:230 E RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4142
Mailing Address - Country:US
Mailing Address - Phone:201-967-4000
Mailing Address - Fax:
Practice Address - Street 1:230 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4142
Practice Address - Country:US
Practice Address - Phone:201-967-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0237736Medicaid
NJ190283YA79Medicare PIN