Healthcare Provider Details

I. General information

NPI: 1750674859
Provider Name (Legal Business Name): XENON HEALTH OF NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 RIVERSIDE PLAZA LN NW STE 100
ALBUQUERQUE NM
87120-1908
US

IV. Provider business mailing address

111 TOWN SQUARE PL STE 420
JERSEY CITY NJ
07310-1724
US

V. Phone/Fax

Practice location:
  • Phone: 917-397-1229
  • Fax: 201-604-6561
Mailing address:
  • Phone: 917-397-1229
  • Fax: 201-604-6561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HAROON CHAUDHRY
Title or Position: PRESIDENT
Credential: MD
Phone: 917-621-6854