Healthcare Provider Details

I. General information

NPI: 1588596993
Provider Name (Legal Business Name): KHASHAYAR HAKHAMANESHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 SUSSEX TPKE STE 120
RANDOLPH NJ
07869-2943
US

IV. Provider business mailing address

13 SHARON CT
RANDOLPH NJ
07869-2607
US

V. Phone/Fax

Practice location:
  • Phone: 973-229-9565
  • Fax:
Mailing address:
  • Phone: 973-229-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01364200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: