Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 25MA07520400 | NJ |
NPI | 1134192495 |
---|---|
Provider Name | Hazen Mahmoud |
First Address | Newark, NJ 07189-0001 |
Second Address | Morristown, NJ 07960-6136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F96698 | (02) | NJ |