Organization
PEDIATRICS & ADOLESCENT SAINT MARY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
INAS WASSEF MD (OWNER)
(646) 388-2111
Entity
Organization
Contact information
Practice address
65 KEARNY AVE, KEARNY, NJ 07032-2334
(646) 388-2111
Mailing address
204 GREEN VALLEY RD, STATEN ISLAND, NY 10312-1825
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
25MA09372400
NJ
Other
Enumeration date
01/08/2016
Last updated
01/08/2016
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