Healthcare Provider Details

I. General information

NPI: 1356107916
Provider Name (Legal Business Name): GARDEN STATE SPECIALTY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 NEW RD STE 2
NORTHFIELD NJ
08225-1179
US

IV. Provider business mailing address

1418 NEW RD STE 2
NORTHFIELD NJ
08225-1179
US

V. Phone/Fax

Practice location:
  • Phone: 609-796-7969
  • Fax:
Mailing address:
  • Phone: 609-642-2663
  • Fax: 609-642-2663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AYEZA MOHSIN
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 609-796-2119