Individual
ISSAM F. MOUBARAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
579A CRANBURY RD, UNIVERSITY RADIOLOGY GROUP, PC, EAST BRUNSWICK, NJ 08816-5426
(732) 390-0040
(732) 390-1856
Mailing address
579A CRANBURY RD, UNIVERSITY RADIOLOGY GROUP, PC, EAST BRUNSWICK, NJ 08816-5426
(732) 390-0040
(732) 390-1856
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
25MA06501100
NJ
2085R0202X
Diagnostic Radiology Physician
MD070556L
PA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
25MA06501100
NJ
2085R0204X
Vascular & Interventional Radiology Physician
MD070556L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03092940
—
NY
05
—
102213146-0001
—
PA
05
—
8132801
—
NJ
Enumeration date
06/30/2005
Last updated
01/18/2011
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