Individual
MAGED T BOUTROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1033 ROUTE 46 STE G1, CLIFTON, NJ 07013-2448
(973) 429-6000
Mailing address
1033 ROUTE 46 EAST, SUITE G1, CLIFTON, NJ 07013
(973) 777-3711
(973) 472-3938
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA08097300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0111759
—
NJ
01
—
0138808
GHI
NJ
01
—
P00359479
RAILROAD
NJ
01
—
P00688848
RAILROAD MEDICARE-HIGHLAND PHYS SRVS
NJ
Enumeration date
07/04/2006
Last updated
07/21/2022
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