Provider Demographics
NPI:1356044531
Name:ABBAS, MARYAM
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:ABBAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 W PLEASANTVIEW AVE STE 14A
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8004
Mailing Address - Country:US
Mailing Address - Phone:201-843-4800
Mailing Address - Fax:
Practice Address - Street 1:370 W PLEASANTVIEW AVE STE 14A
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8004
Practice Address - Country:US
Practice Address - Phone:201-843-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ22DI02986201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program