Provider Demographics
NPI:1326268905
Name:JAVAD NAFICY, MD PA
Entity Type:Organization
Organization Name:JAVAD NAFICY, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:NAFICY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-942-1000
Mailing Address - Street 1:601 HAMBURG TPKE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2048
Mailing Address - Country:US
Mailing Address - Phone:973-942-1000
Mailing Address - Fax:862-264-1130
Practice Address - Street 1:601 HAMBURG TPKE
Practice Address - Street 2:SUITE 311
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2048
Practice Address - Country:US
Practice Address - Phone:973-942-1000
Practice Address - Fax:862-264-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02990700102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096852Medicare ID - Type Unspecified