Provider Demographics
NPI:1194738708
Name:GERGES, MAGED MOUSSA (MD)
Entity type:Individual
Prefix:
First Name:MAGED
Middle Name:MOUSSA
Last Name:GERGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 WALT WHITMAN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4300
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:1 CLARA MAASS DRIVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109
Practice Address - Country:US
Practice Address - Phone:908-653-9399
Practice Address - Fax:908-853-9305
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07378500207L00000X
NY223515207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8959404Medicaid
H76144Medicare UPIN
NJ065692DJAMedicare PIN