Healthcare Provider Details

I. General information

NPI: 1629138102
Provider Name (Legal Business Name): KEY PHYSMED PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MAPLE PL
KEYPORT NJ
07735-1144
US

IV. Provider business mailing address

250 MAPLE PL
KEYPORT NJ
07735-1144
US

V. Phone/Fax

Practice location:
  • Phone: 732-264-2714
  • Fax: 732-264-9412
Mailing address:
  • Phone: 732-264-2714
  • Fax: 732-264-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: FAHEEM A ABBASI
Title or Position: PRESIDENT
Credential: MD
Phone: 732-264-2714