Organization
MEDICAL AND GERATRIC ASSOCIATE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORIS MANSOUR M.D (BOARD OF DIRECTORS)
(201) 747-1684
Entity
Organization
Contact information
Practice address
2239 CENTER AVE, FORT LEE, NJ 07024-6123
(201) 747-1684
Mailing address
PO BOX 52, FORT LEE, NJ 07024-0052
(201) 747-1684
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
25MA07927200
NJ
Other
Enumeration date
06/28/2010
Last updated
06/28/2010
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