Healthcare Provider Details

I. General information

NPI: 1609001130
Provider Name (Legal Business Name): HEKMAT KHODR ZARZOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 HURFFVILLE CROSSKEYS RD SUITE B16
SEWELL NJ
08080-2337
US

IV. Provider business mailing address

445 HURFFVILLE CROSSKEYS RD SUITE B16
SEWELL NJ
08080-2337
US

V. Phone/Fax

Practice location:
  • Phone: 856-256-7591
  • Fax:
Mailing address:
  • Phone: 856-256-7591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberN/A
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number25MA09852900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD457829
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: