Healthcare Provider Details

I. General information

NPI: 1700200623
Provider Name (Legal Business Name): KALUNJI HASHIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 N BROAD ST
PHILADELPHIA PA
19132-4013
US

IV. Provider business mailing address

2456 N MYRTLEWOOD ST
PHILADELPHIA PA
19132-3014
US

V. Phone/Fax

Practice location:
  • Phone: 215-599-2845
  • Fax: 215-599-1043
Mailing address:
  • Phone: 267-283-5548
  • Fax: 215-599-1043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: