Provider Demographics
NPI:1275508541
Name:KOMBOZ, RITA FARES (MD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:FARES
Last Name:KOMBOZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FRANKLIN AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3532
Mailing Address - Country:US
Mailing Address - Phone:973-844-0049
Mailing Address - Fax:973-751-9955
Practice Address - Street 1:5 FRANKLIN AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3532
Practice Address - Country:US
Practice Address - Phone:973-844-0049
Practice Address - Fax:973-751-9955
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA65810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG79322Medicare UPIN