Healthcare Provider Details

I. General information

NPI: 1932995230
Provider Name (Legal Business Name): FREDDIE USA OF NEW JERSEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13331 NACOGDOCHES RD
SAN ANTONIO TX
78217
US

IV. Provider business mailing address

180 TALMADGE RD UNIT #312
EDISON NJ
08817
US

V. Phone/Fax

Practice location:
  • Phone: 423-275-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEX MOHSENI
Title or Position: PRESIDENT
Credential:
Phone: 301-706-4461