Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA03599800 | NJ |
NPI | 1104873272 |
---|---|
Provider Name | Dr. Mona Mahrous Tantawi |
First Address | Hackensack, NJ 07601-1311 |
Second Address | Hackensack, NJ 07601-1311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 08/07/2007 |