MEDICARE: FAWAZ KASHLAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	25MA06203200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205040425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAWAZ KASHLAN

Provider Business Mailing Address
First Line	:	66 WEST GILBERT ST
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 SPRINGHOUSE RD
Second Line	:
City	:	OCEAN
State	:	NJ
Zip	:	07712-3727
Country	:	US
Telephone Number	:	732-922-4763
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	05/14/2008

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