Provider Demographics
NPI:1619017589
Name:MARWAN ASSALEH, MD, PC
Entity type:Organization
Organization Name:MARWAN ASSALEH, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSALEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-653-9115
Mailing Address - Street 1:591 SUMMIT AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2714
Mailing Address - Country:US
Mailing Address - Phone:201-653-9115
Mailing Address - Fax:
Practice Address - Street 1:591 SUMMIT AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2714
Practice Address - Country:US
Practice Address - Phone:201-653-9115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05278500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty