Provider Demographics
NPI:1578667119
Name:KHAZAI, KAMRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:
Last Name:KHAZAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WILLIAMSON ST
Mailing Address - Street 2:SUITE 405
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:SUITE 405
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
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06505500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010065055NJ01OtherANTHEM HEALTH
NJ2217632OtherUNITED HEALTH CARE
NJ223832708OtherNJ CARPENTERS FUND
NJ223832708OtherQUAL CARE
NJ223832708OtherCONSUMER HEALTH NETWORK
NJ223832708OtherMAGNA CARE
NJP2555106OtherOXFORD
NJ01000360102OtherAMERICHOICE
NJ223832708OtherBC/BS
NJ7479271OtherAETNA USHC
NJ0299190OtherGHI
NJ64712004OtherCIGNA
NH223832708OtherDEVON
NJ223832708OtherONE HEALTH PLAN
NJ223832708OtherBEECH STREET
NJ223832708OtherBETTER HEALTH ADVANTAGE
NJ223832708OtherBC/BS
NJ223832708OtherBEECH STREET