Mary Fares Mallouhi, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DI21703 Issued in NJ

Practice address

394 Main St
Hackensack, NJ 07601-5805

Phone

(201) 525-0067

Fax

(201) 525-0070

NPI assigned

Mar 19, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1164546669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "394 MAIN ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076015805",
            "telephone_number": "201-525-0067",
            "fax_number": "201-525-0070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "394 MAIN ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076015805",
            "telephone_number": "201-525-0067",
            "fax_number": "201-525-0070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLOUHI",
        "first_name": "MARY",
        "middle_name": "FARES",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-19",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "DI21703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0114031",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danish Sohaib Malik, MD
• Quratul Ain Malik, DDS
• Carrie R. Mallen
• Grace Malley, MD
• Rajit Bhoosa Malliah, M.D.
• Katherine Malmrose, M.S., CCC-SLP
• Mam Orthopaedics, PA
• Judith Mamah, D.M.D.
• Jeremy Robert Man, M.D.
• Lauren Kristen Mancuso, MSN, FNP-BC, FNP-C

• General Practice Dentistry in Hackensack, NJ
• Providers in Hackensack, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.