Provider Demographics
NPI:1326464041
Name:AWAN, ZOHRA (LAC)
Entity Type:Individual
Prefix:
First Name:ZOHRA
Middle Name:
Last Name:AWAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 STATE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1300
Mailing Address - Country:US
Mailing Address - Phone:609-608-0181
Mailing Address - Fax:
Practice Address - Street 1:11 STATE RD STE 300
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1300
Practice Address - Country:US
Practice Address - Phone:609-608-0181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000173171100000X
NJ25MZ00104600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist