Healthcare Provider Details

I. General information

NPI: 1265345375
Provider Name (Legal Business Name): BLUE CRESCENT BLUE SUMMIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 DANIEL ST
CARTERET NJ
07008-2045
US

IV. Provider business mailing address

95 DANIEL ST
CARTERET NJ
07008-2045
US

V. Phone/Fax

Practice location:
  • Phone: 917-584-7173
  • Fax:
Mailing address:
  • Phone: 917-584-7173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ZOHA HASSAN
Title or Position: CEO
Credential:
Phone: 917-584-7173