Healthcare Provider Details

I. General information

NPI: 1871288605
Provider Name (Legal Business Name): TAHA AWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVERVIEW PLZ
RED BANK NJ
07701-1864
US

IV. Provider business mailing address

833 CHESTNUT ST STE 220
PHILADELPHIA PA
19107-4405
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MA13111400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: