Provider Demographics
NPI:1427257583
Name:M M MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:M M MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOURAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-458-0114
Mailing Address - Street 1:PO BOX 1217
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-0717
Mailing Address - Country:US
Mailing Address - Phone:973-458-0114
Mailing Address - Fax:973-458-0661
Practice Address - Street 1:29 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-3309
Practice Address - Country:US
Practice Address - Phone:973-458-0114
Practice Address - Fax:973-458-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07839900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI140149Medicare UPIN