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Organization
AVICENNA MEDICAL GROUP, LLC
Active
Organization
AVICENNA MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FADI SAMAAN MBA, MS (MANAGER)
(646) 464-3110
Entity
Organization
Contact information
Practice address
414 EAGLE ROCK AVE, SUITE 307, WEST ORANGE, NJ 07052-4224
(646) 464-3110
Mailing address
414 EAGLE ROCK AVE, SUITE 307, WEST ORANGE, NJ 07052-4224
(646) 464-3110
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
25MB07627000
NJ
Other
Enumeration date
03/20/2013
Last updated
03/22/2013
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