Basic Information
| Provider Information | |||||||||
| NPI: | 1265179881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAB | ||||||||
| FirstName: | MAROUN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 OVERBROOK CIR | ||||||||
| Address2: | |||||||||
| City: | MOORESTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080572211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9174127293 | ||||||||
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| Practice Location | |||||||||
| Address1: | 222 STATION PLZ N STE 509 | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115013893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166632381 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2022 | ||||||||
| LastUpdateDate: | 05/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.