Healthcare Provider Details

I. General information

NPI: 1073338489
Provider Name (Legal Business Name): GHOSIA IQBAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 APOLLO AVE
AVENEL NJ
07001-1430
US

IV. Provider business mailing address

29 APOLLO AVE
AVENEL NJ
07001-1430
US

V. Phone/Fax

Practice location:
  • Phone: 732-520-8877
  • Fax: 732-710-4113
Mailing address:
  • Phone: 732-520-8877
  • Fax: 732-710-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: