Healthcare Provider Details

I. General information

NPI: 1306198775
Provider Name (Legal Business Name): WAYNE TMS INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HAMBURG TPKE SUITE 302
WAYNE NJ
07470-2154
US

IV. Provider business mailing address

401 HAMBURG TPKE SUITE 302
WAYNE NJ
07470-2154
US

V. Phone/Fax

Practice location:
  • Phone: 973-790-9222
  • Fax: 973-790-0671
Mailing address:
  • Phone: 973-790-9222
  • Fax: 973-790-0671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA05085700
License Number StateNJ

VIII. Authorized Official

Name: DR. MOHAMED A ELRAFEI
Title or Position: PSYCHIATRIST, OWNER
Credential: M.D.
Phone: 973-790-9222