Provider Demographics
NPI:1104873272
Name:TANTAWI, MONA MAHROUS (MD)
Entity type:Individual
Prefix:DR
First Name:MONA
Middle Name:MAHROUS
Last Name:TANTAWI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MONA
Other - Middle Name:M
Other - Last Name:TANTAWI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:177 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1311
Mailing Address - Country:US
Mailing Address - Phone:201-487-8222
Mailing Address - Fax:201-487-2126
Practice Address - Street 1:177 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1311
Practice Address - Country:US
Practice Address - Phone:201-487-8222
Practice Address - Fax:201-487-2126
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA035998002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine