Provider Demographics
NPI:1891410494
Name:CAREND PROVIDER GROUP OF NEW JERSEY PC
Entity Type:Organization
Organization Name:CAREND PROVIDER GROUP OF NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AWSS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-534-5527
Mailing Address - Street 1:2045 W GRAND AVE STE B
Mailing Address - Street 2:PMB 89496
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:708-872-7108
Mailing Address - Fax:
Practice Address - Street 1:101 EISENHOWER PKWY STE 300
Practice Address - Street 2:PMB 3146
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-0706
Practice Address - Country:US
Practice Address - Phone:708-872-7108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty