Provider Demographics
NPI:1124333133
Name:ABBASSI, MAHMOUD (RPH)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:ABBASSI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 EAST DR
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1212
Mailing Address - Country:US
Mailing Address - Phone:201-543-9920
Mailing Address - Fax:
Practice Address - Street 1:111 MARKET ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2809
Practice Address - Country:US
Practice Address - Phone:973-624-4999
Practice Address - Fax:973-624-8918
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01581200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist