Healthcare Provider Details

I. General information

NPI: 1508001827
Provider Name (Legal Business Name): PISCATAWAY HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 VAIL AVE
PISCATAWAY NJ
08854-1500
US

IV. Provider business mailing address

366 VAIL AVE
PISCATAWAY NJ
08854-1500
US

V. Phone/Fax

Practice location:
  • Phone: 732-968-2811
  • Fax: 732-968-7769
Mailing address:
  • Phone: 732-968-2811
  • Fax: 732-968-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number25MAO4025500
License Number StateNJ

VIII. Authorized Official

Name: ZAI M KARU
Title or Position: BUSINESS
Credential: ETC
Phone: 732-968-2811