Provider Demographics
NPI:1407041312
Name:ALNACHAWATI, MHD HICHAM (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MHD HICHAM
Middle Name:
Last Name:ALNACHAWATI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MHD HICHAM
Other - Middle Name:
Other - Last Name:ALNACHAWATI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:50 STATE RT 5
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6323
Mailing Address - Country:US
Mailing Address - Phone:617-699-2025
Mailing Address - Fax:
Practice Address - Street 1:2960 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6605
Practice Address - Country:US
Practice Address - Phone:718-370-2014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA094276002083X0100X, 208D00000X
MI4301093387208D00000X
NY255649208D00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice