Healthcare Provider Details

I. General information

NPI: 1588646400
Provider Name (Legal Business Name): MARIA LOURDERS SILVA-KHAZAEI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 N WOOD AVE STE 201
LINDEN NJ
07036-4058
US

IV. Provider business mailing address

812 N WOOD AVE STE 201
LINDEN NJ
07036-4058
US

V. Phone/Fax

Practice location:
  • Phone: 908-353-2064
  • Fax: 908-353-5052
Mailing address:
  • Phone: 908-353-2064
  • Fax: 908-353-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA64906
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: