Healthcare Provider Details

I. General information

NPI: 1104770650
Provider Name (Legal Business Name): SOUTH ORANGE HEALTHCARE CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 S ORANGE AVE
SOUTH ORANGE NJ
07079-1715
US

IV. Provider business mailing address

73 S ORANGE AVE
SOUTH ORANGE NJ
07079-1715
US

V. Phone/Fax

Practice location:
  • Phone: 973-821-5414
  • Fax: 973-275-5220
Mailing address:
  • Phone: 973-821-5414
  • Fax: 973-275-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALI MUJAHID
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 973-821-5414