Provider Demographics
NPI:1578875266
Name:WOMEN PELVIC SURGERY OF NORTH JERSEY LLC
Entity Type:Organization
Organization Name:WOMEN PELVIC SURGERY OF NORTH JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHASHAYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKIBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-809-2724
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07451-0666
Mailing Address - Country:US
Mailing Address - Phone:203-809-2724
Mailing Address - Fax:973-773-2038
Practice Address - Street 1:330 RATZER RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7702
Practice Address - Country:US
Practice Address - Phone:203-809-2724
Practice Address - Fax:973-773-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty