Provider Demographics
NPI:1548341662
Name:MOUSSA, GHIAS (MD)
Entity type:Individual
Prefix:MR
First Name:GHIAS
Middle Name:
Last Name:MOUSSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LOVEYS DR
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2801
Mailing Address - Country:US
Mailing Address - Phone:201-333-3311
Mailing Address - Fax:201-333-4831
Practice Address - Street 1:1815 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305
Practice Address - Country:US
Practice Address - Phone:201-333-3311
Practice Address - Fax:201-333-4831
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51676207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1107266OtherHORIZON NJ
NJ0144801Medicaid
NJ0144801Medicaid
NJ1107266OtherHORIZON NJ