Provider Demographics
NPI: | 1528370236 |
---|---|
Name: | NEW JERSEY WOMENS CARE |
Entity Type: | Organization |
Organization Name: | NEW JERSEY WOMENS CARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | KAMRAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KHAZAI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 908-353-5551 |
Mailing Address - Street 1: | 240 WILLIAMSON ST |
Mailing Address - Street 2: | |
Mailing Address - City: | ELIZABETH |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07202-3674 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 908-353-5551 |
Mailing Address - Fax: | 908-353-5052 |
Practice Address - Street 1: | 240 WILLIAMSON ST |
Practice Address - Street 2: | SUITE405 |
Practice Address - City: | ELIZABETH |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07202-3674 |
Practice Address - Country: | US |
Practice Address - Phone: | 908-353-5551 |
Practice Address - Fax: | 908-353-5052 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-07-10 |
Last Update Date: | 2010-07-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 25MA06505500 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Single Specialty |