Healthcare Provider Details

I. General information

NPI: 1326090135
Provider Name (Legal Business Name): ROOHI KAMAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SUMMIT AVE
HACKENSACK NJ
07601-1429
US

IV. Provider business mailing address

331 SUMMIT AVE
HACKENSACK NJ
07601-1429
US

V. Phone/Fax

Practice location:
  • Phone: 201-457-2300
  • Fax: 201-457-1715
Mailing address:
  • Phone: 201-457-2300
  • Fax: 201-457-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA07006900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9105000
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: