Healthcare Provider Details

I. General information

NPI: 1861173130
Provider Name (Legal Business Name): NORTHWELL HEALTH MEDICAL NJ, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RIVER RD
EDGEWATER NJ
07020-1171
US

IV. Provider business mailing address

1111 MARCUS AVE STE M04
NEW HYDE PARK NY
11042-1034
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-4664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. HARMIT KALIA
Title or Position: DIRECTOR STRATEGIC DEVELOPMENT
Credential: DO
Phone: 516-562-4664