Healthcare Provider Details

I. General information

NPI: 1326584715
Provider Name (Legal Business Name): MYRIAM KAWAJA MS,CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MADISON AVE STE 107
MORRISTOWN NJ
07960-7305
US

IV. Provider business mailing address

5 MARINE VIEW PLZ
HOBOKEN NJ
07030-5756
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-7634
  • Fax: 973-290-7430
Mailing address:
  • Phone: 201-706-4524
  • Fax: 201-706-7649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number25MJ00004900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: