Provider Demographics
NPI:1114972064
Name:MEDICAL GROUP OF NORTH JERSEY
Entity Type:Organization
Organization Name:MEDICAL GROUP OF NORTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:NIZAR
Authorized Official - Last Name:KAHF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-942-3767
Mailing Address - Street 1:401 HALEDON AVE
Mailing Address - Street 2:
Mailing Address - City:HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-1553
Mailing Address - Country:US
Mailing Address - Phone:973-942-3767
Mailing Address - Fax:
Practice Address - Street 1:401 HALEDON AVE
Practice Address - Street 2:
Practice Address - City:HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-1553
Practice Address - Country:US
Practice Address - Phone:973-942-3767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA44774174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0183504Medicaid
NJC45125Medicare UPIN
NJ439221Medicare ID - Type Unspecified