Healthcare Provider Details

I. General information

NPI: 1164340444
Provider Name (Legal Business Name): EVERGREEN MEDICAL SPECIALTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 WESTFIELD AVE
RAHWAY NJ
07065-2040
US

IV. Provider business mailing address

1053 WESTFIELD AVE
RAHWAY NJ
07065-2040
US

V. Phone/Fax

Practice location:
  • Phone: 908-888-0032
  • Fax:
Mailing address:
  • Phone: 908-888-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MEENA AHLUWALIA
Title or Position: OWNER
Credential: MD
Phone: 908-888-0032