Medical and Geratric Associate PC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

25MA07927200 Issued in NJ

Legal business name

MEDICAL AND GERATRIC ASSOCIATE PC

Practice address

2239 Center Ave
Fort Lee, NJ 07024-6123

Phone

(201) 747-1684

NPI assigned

Jun 28, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Loris Mansour, M.D

Title

Board of Directors

Phone

(201) 747-1684

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1277683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277683200000",
    "number": "1871804534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070240052",
            "telephone_number": "201-747-1684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2239 CENTER AVE",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070246123",
            "telephone_number": "201-747-1684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL AND GERATRIC ASSOCIATE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-28",
        "last_updated": "2010-06-28",
        "status": "A",
        "authorized_official_last_name": "MANSOUR",
        "authorized_official_first_name": "LORIS",
        "authorized_official_title_or_position": "BOARD OF DIRECTORS",
        "authorized_official_telephone_number": "201-747-1684",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "25MA07927200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in Fort Lee, NJ
• Providers in Fort Lee, NJ by specialty
• Geriatric Medicine (Internal Medicine) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.