Provider Demographics
NPI:1073080073
Name:TAHA, RAED
Entity Type:Individual
Prefix:MR
First Name:RAED
Middle Name:
Last Name:TAHA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RAED
Other - Middle Name:
Other - Last Name:TAHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 STEVENS DR
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2209
Mailing Address - Country:US
Mailing Address - Phone:908-377-9448
Mailing Address - Fax:
Practice Address - Street 1:6 STEVENS DR
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-2209
Practice Address - Country:US
Practice Address - Phone:908-377-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-28
Last Update Date:2018-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00809600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist