Provider Demographics
NPI:1942266978
Name:BEHNAM, KAZEM (MD)
Entity Type:Individual
Prefix:
First Name:KAZEM
Middle Name:
Last Name:BEHNAM
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 1:309 IROQUOIS LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1047
Mailing Address - Country:US
Mailing Address - Phone:201-447-1620
Mailing Address - Fax:201-447-4977
Practice Address - Street 1:317 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3316
Practice Address - Country:US
Practice Address - Phone:201-447-1620
Practice Address - Fax:201-447-4977
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJMA28296207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3190803Medicaid
C55654Medicare UPIN
454870Medicare ID - Type Unspecified