Provider Demographics
NPI:1912299777
Name:ATHENA HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:ATHENA HEALTHCARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHASHAYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-826-8290
Mailing Address - Street 1:145 RTE 46 W
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6830
Mailing Address - Country:US
Mailing Address - Phone:973-826-8290
Mailing Address - Fax:866-760-4555
Practice Address - Street 1:145 RTE 46 W
Practice Address - Street 2:SUITE 304
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6830
Practice Address - Country:US
Practice Address - Phone:973-826-8290
Practice Address - Fax:866-760-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty