Healthcare Provider Details

I. General information

NPI: 1528370236
Provider Name (Legal Business Name): NEW JERSEY WOMENS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 07/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLIAMSON ST SUITE405
ELIZABETH NJ
07202-3674
US

IV. Provider business mailing address

240 WILLIAMSON ST
ELIZABETH NJ
07202-3674
US

V. Phone/Fax

Practice location:
  • Phone: 908-353-5551
  • Fax: 908-353-5052
Mailing address:
  • Phone: 908-353-5551
  • Fax: 908-353-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA06505500
License Number StateNJ

VIII. Authorized Official

Name: DR. KAMRAN KHAZAI
Title or Position: OWNER
Credential: MD
Phone: 908-353-5551