Provider Demographics
NPI:1598581746
Name:AWAD, MOHAMED AHMED
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:AHMED
Last Name:AWAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 VREELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2931
Mailing Address - Country:US
Mailing Address - Phone:201-351-3055
Mailing Address - Fax:
Practice Address - Street 1:75 ORIENT WAY STE 301
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2086
Practice Address - Country:US
Practice Address - Phone:201-351-3055
Practice Address - Fax:201-351-3184
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02304000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist