Basic Information
| Provider Information | |||||||||
| NPI: | 1487728291 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOULOU | ||||||||
| FirstName: | MAJD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 396 BROADWAY | ||||||||
| Address2: | MID HUDSON PHYSICIANS, PC | ||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124014626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453313131 | ||||||||
| FaxNumber: | 8453342898 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MEDICAL CENTER WAY FL 4 | ||||||||
| Address2: | |||||||||
| City: | SOMERS POINT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082442300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093656200 | ||||||||
| FaxNumber: | 6099264311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 09/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 242168 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 25MA08542700 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02913133 | 05 | NY | MEDICAID | 1487728291 | 01 | NPI | OTHER |