Basic Information
Provider Information
NPI: 1003148826
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GAID
FirstName: MAGED
MiddleName: ROSHDAY
NamePrefix: MR.
NameSuffix:  
Credential: PHARM D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 325 SPRINGFIELD AVE
Address2:  
City: NEWARK
State: NJ
PostalCode: 071032622
CountryCode: US
TelephoneNumber: 9738241147
FaxNumber:  
Practice Location
Address1: 325 SPRINGFIELD AVE
Address2:  
City: NEWARK
State: NJ
PostalCode: 071032622
CountryCode: US
TelephoneNumber: 9738241147
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/03/2010
LastUpdateDate: 02/06/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X049989-1NYN Pharmacy Service ProvidersPharmacist 
183500000X28RI02880000NJY Pharmacy Service ProvidersPharmacist 

No ID Information.


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