Provider Demographics
NPI:1538513262
Name:MEMON, MOOMAL (MD)
Entity type:Individual
Prefix:
First Name:MOOMAL
Middle Name:
Last Name:MEMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 W JIMMIE LEEDS RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9438
Mailing Address - Country:US
Mailing Address - Phone:609-407-7300
Mailing Address - Fax:609-404-7301
Practice Address - Street 1:54 W JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9438
Practice Address - Country:US
Practice Address - Phone:609-404-7300
Practice Address - Fax:609-404-7301
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10346600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine