Healthcare Provider Details

I. General information

NPI: 1972063055
Provider Name (Legal Business Name): MARYAM KAZMI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 ROUTE 3 STE 107
SECAUCUS NJ
07094-3857
US

IV. Provider business mailing address

3 UNIVERSITY PLZ STE 205
HACKENSACK NJ
07601-6208
US

V. Phone/Fax

Practice location:
  • Phone: 551-236-5550
  • Fax:
Mailing address:
  • Phone: 201-833-3599
  • Fax: 201-227-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MB13074900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: