Healthcare Provider Details

I. General information

NPI: 1114972064
Provider Name (Legal Business Name): MEDICAL GROUP OF NORTH JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HALEDON AVE
HALEDON NJ
07508-1553
US

IV. Provider business mailing address

401 HALEDON AVE
HALEDON NJ
07508-1553
US

V. Phone/Fax

Practice location:
  • Phone: 973-942-3767
  • Fax:
Mailing address:
  • Phone: 973-942-3767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA44774
License Number StateNJ

VIII. Authorized Official

Name: DR. AHMAD NIZAR KAHF
Title or Position: OWNER
Credential: MD
Phone: 973-942-3767