Provider Demographics
NPI:1629308895
Name:ADVANCED GERIATRICS INC
Entity Type:Organization
Organization Name:ADVANCED GERIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGWA
Authorized Official - Middle Name:ISMAIL
Authorized Official - Last Name:HAFEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-790-3433
Mailing Address - Street 1:27 ALMADERA DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2471
Mailing Address - Country:US
Mailing Address - Phone:973-790-3433
Mailing Address - Fax:973-790-0433
Practice Address - Street 1:246 HAMBURG TPKE
Practice Address - Street 2:SUITE 208
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2156
Practice Address - Country:US
Practice Address - Phone:973-790-3433
Practice Address - Fax:973-790-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA08232200207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0152811Medicaid