Provider Demographics
NPI:1356651319
Name:JAVAD KHAVARIAN MD PA
Entity Type:Organization
Organization Name:JAVAD KHAVARIAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPAEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAVARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-739-3130
Mailing Address - Street 1:733 N BEERS ST
Mailing Address - Street 2:SUITE L3
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1528
Mailing Address - Country:US
Mailing Address - Phone:732-739-3130
Mailing Address - Fax:732-739-1783
Practice Address - Street 1:733 N BEERS ST
Practice Address - Street 2:SUITE L3
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1528
Practice Address - Country:US
Practice Address - Phone:732-739-3130
Practice Address - Fax:732-739-1783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02527500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3068200-01 NJMedicaid
NJ427444OtherMEDICARE/PTAN
NJ427444OtherMEDICARE/PTAN