Provider Demographics
NPI:1316024946
Name:HAJJAR, BASSAM (MD)
Entity type:Individual
Prefix:MR
First Name:BASSAM
Middle Name:
Last Name:HAJJAR
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:PO BOX 7996
Mailing Address - Street 2:
Mailing Address - City:HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07538-7996
Mailing Address - Country:US
Mailing Address - Phone:973-595-6444
Mailing Address - Fax:973-782-4819
Practice Address - Street 1:1300 MAIN AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2266
Practice Address - Country:US
Practice Address - Phone:973-595-6444
Practice Address - Fax:973-782-4819
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07031400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8133808Medicaid
NJ034881Medicare ID - Type UnspecifiedMEDICARE NJ
NJ8133808Medicaid