Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MA47466 | NJ |
NPI | 1003969387 |
---|---|
Provider Name | Dr. Gamal M Diab |
First Address | Denville, NJ 07834-0569 |
Second Address | Parsippany, NJ 07054-2986 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 30/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0424005 | (05) | NJ |
070094 | MEDICARE GROUP (01) | NJ |
D73195 | (02) | NJ |