Provider Demographics
NPI:1770997140
Name:HAZLET MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:HAZLET MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELFAWWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-217-3208
Mailing Address - Street 1:1 BETHANY RD
Mailing Address - Street 2:BLDG #2, STE #25
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1660
Mailing Address - Country:US
Mailing Address - Phone:732-217-3208
Mailing Address - Fax:732-217-3107
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:BLDG #2, STE #25
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1660
Practice Address - Country:US
Practice Address - Phone:732-217-3208
Practice Address - Fax:732-217-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0444740Medicaid
NJ8688206Medicaid