Provider Demographics
NPI:1750688644
Name:GENERAL HEALTH GROUP LLC
Entity Type:Organization
Organization Name:GENERAL HEALTH GROUP LLC
Other - Org Name:GENERAL CLINICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MASOOD
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-868-0257
Mailing Address - Street 1:7511 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5459
Mailing Address - Country:US
Mailing Address - Phone:201-868-0257
Mailing Address - Fax:
Practice Address - Street 1:7511 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5459
Practice Address - Country:US
Practice Address - Phone:201-868-0257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02845500207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3716503Medicaid
NJ213506Medicare PIN
NJ088598Medicare PIN