Healthcare Provider Details

I. General information

NPI: 1447649694
Provider Name (Legal Business Name): CENTRAL AVENUE PROFESSIONAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CENTRAL AVE
NEWARK NJ
07102-1909
US

IV. Provider business mailing address

111 CENTRAL AVE
NEWARK NJ
07102-1909
US

V. Phone/Fax

Practice location:
  • Phone: 973-877-5300
  • Fax: 973-877-5317
Mailing address:
  • Phone: 973-877-5300
  • Fax: 973-877-5317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SYED KAZMI
Title or Position: OWNER
Credential: M.D.
Phone: 973-877-5300