Healthcare Provider Details

I. General information

NPI: 1063359115
Provider Name (Legal Business Name): KEREN KHAWAJA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MAIN ST
EDISON NJ
08837-3418
US

IV. Provider business mailing address

1758 CHRISTOPHER RD
HAZLETON PA
18201-5626
US

V. Phone/Fax

Practice location:
  • Phone: 732-582-0400
  • Fax:
Mailing address:
  • Phone: 570-436-6941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15322100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: