Organization
TRI TOWN MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMED KAWAM M.D. (DELEGATED OFFICIAL)
(973) 942-3200
Entity
Organization
Contact information
Practice address
160 HALEDON AVE, PROSPECT PARK, NJ 07508-2051
(973) 942-3200
(973) 942-2901
Mailing address
PO BOX 3400, WAYNE, NJ 07474-3400
(973) 942-3200
(973) 942-2901
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA06054400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2626509001
AMERIHEALTH GROUP #
NJ
Enumeration date
11/09/2006
Last updated
04/20/2008
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