Provider Demographics
NPI:1285114926
Name:MABROUK, TARIG (MD)
Entity type:Individual
Prefix:DR
First Name:TARIG
Middle Name:
Last Name:MABROUK
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 1:706 NOTTINGHILL LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-4009
Mailing Address - Country:US
Mailing Address - Phone:347-410-0422
Mailing Address - Fax:
Practice Address - Street 1:706 NOTTINGHILL LN
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-4009
Practice Address - Country:US
Practice Address - Phone:347-410-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29N00000207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine