Healthcare Provider Details

I. General information

NPI: 1780995019
Provider Name (Legal Business Name): ASSOCIATED HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 08/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 HAMBURG TPKE SUITE 5
WAYNE NJ
07470-2062
US

IV. Provider business mailing address

516 HAMBURG TPKE SUITE 5
WAYNE NJ
07470-2062
US

V. Phone/Fax

Practice location:
  • Phone: 973-790-3000
  • Fax: 973-790-3001
Mailing address:
  • Phone: 973-790-3000
  • Fax: 973-790-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MCOO364300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMAO59982
License Number StateNJ

VIII. Authorized Official

Name: DR. SONIA MOHAMMED GOF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 973-790-3000