Provider Demographics
NPI:1881041192
Name:SHOMAF NAKHJO, D.O. LLC
Entity Type:Organization
Organization Name:SHOMAF NAKHJO, D.O. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHOMAF
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKHJO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-490-0036
Mailing Address - Street 1:45 S PARK PL
Mailing Address - Street 2:#302
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-3924
Mailing Address - Country:US
Mailing Address - Phone:908-490-0036
Mailing Address - Fax:908-490-0067
Practice Address - Street 1:222 HIGH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-9604
Practice Address - Country:US
Practice Address - Phone:908-490-0036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08739300208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1184831406OtherPERSONAL NPI