Healthcare Provider Details

I. General information

NPI: 1184341117
Provider Name (Legal Business Name): FORT HEALTH MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 5TH AVE FL 8
NEW YORK NY
10003-3019
US

IV. Provider business mailing address

613 WASHINGTON BLVD # 1297
JERSEY CITY NJ
07310-2900
US

V. Phone/Fax

Practice location:
  • Phone: 908-285-6686
  • Fax:
Mailing address:
  • Phone: 201-208-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SABA HAQ
Title or Position: PRESIDENT
Credential: MD
Phone: 949-463-0650