Provider Demographics
NPI:1124287255
Name:SAMI M MAMOUN MD PA
Entity type:Organization
Organization Name:SAMI M MAMOUN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAMOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:973-226-7565
Mailing Address - Street 1:188 EAGLE ROCK AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1723
Mailing Address - Country:US
Mailing Address - Phone:973-226-7565
Mailing Address - Fax:973-226-4645
Practice Address - Street 1:188 EAGLE ROCK AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1723
Practice Address - Country:US
Practice Address - Phone:973-226-7565
Practice Address - Fax:973-226-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty