Healthcare Provider Details

I. General information

NPI: 1700931680
Provider Name (Legal Business Name): JOHN S KASHANI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CENTRAL AVE
NEWARK NJ
07102-1909
US

IV. Provider business mailing address

66 W GILBERT ST
TINTON FALLS NJ
07701-4947
US

V. Phone/Fax

Practice location:
  • Phone: 973-877-5000
  • Fax:
Mailing address:
  • Phone: 732-212-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number25MB07923700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: