Provider Demographics
NPI:1609144096
Name:MASSAPEQUA MEDICAL PC
Entity type:Organization
Organization Name:MASSAPEQUA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-798-8090
Mailing Address - Street 1:727 N BROADWAY
Mailing Address - Street 2:SUITE A1
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2348
Mailing Address - Country:US
Mailing Address - Phone:516-798-8090
Mailing Address - Fax:516-795-3606
Practice Address - Street 1:727 N BROADWAY
Practice Address - Street 2:SUITE A1
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2348
Practice Address - Country:US
Practice Address - Phone:516-798-8090
Practice Address - Fax:516-795-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233296261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty