Basic Information
| Provider Information | |||||||||
| NPI: | 1629155429 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INFECTIOUS DISEASE CENTER OF NEW JERSEY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 273 | ||||||||
| Address2: | |||||||||
| City: | WHIPPANY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079810273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735358355 | ||||||||
| FaxNumber: | 9735358353 | ||||||||
| Practice Location | |||||||||
| Address1: | 568 ROUTE 10 W | ||||||||
| Address2: | |||||||||
| City: | WHIPPANY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079811516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735358355 | ||||||||
| FaxNumber: | 9735358353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 10/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | YOUSSEF-BESSLER | ||||||||
| AuthorizedOfficialFirstName: | MANAL | ||||||||
| AuthorizedOfficialMiddleName: | FAROUK | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9735358355 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MA07758200 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.