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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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