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NPI Code Detail

MEDICARE: KHADIJAH A FORMAN

MEDICARE: KHADIJAH A FORMAN
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
11041C0700XClinical Social Worker44SC06646800NJ

General Provider Information

NPI Number : 1760264956
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHADIJAH A FORMAN
Provider Business Mailing Address
First Line : 610 VALLEY HEALTH PLZ
Second Line :
City : PARAMUS
State : NJ
Zip : 07652-3607
Country : US
Telephone Number : 201-265-8200
Fax Number :
Provider Business Practice Location Address
First Line : 610 VALLEY HEALTH PLZ
Second Line :
City : PARAMUS
State : NJ
Zip : 07652-3607
Country : US
Telephone Number : 201-265-8200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2023
Last Update Date : 04/13/2026

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Directions to “ KHADIJAH A FORMAN ” Practice Location

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