Provider Demographics
NPI:1598815987
Name:KANJ, HASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:
Last Name:KANJ
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 1:20 WILLS WAY
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3770
Mailing Address - Country:US
Mailing Address - Phone:732-562-0027
Mailing Address - Fax:732-562-0041
Practice Address - Street 1:20 WILLS WAY
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3770
Practice Address - Country:US
Practice Address - Phone:732-562-0027
Practice Address - Fax:732-562-0041
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 50257174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE48153Medicare UPIN
NJ509135 PFLMedicare ID - Type Unspecified