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General NPI Number Information
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NPI Number | 1093012650
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Entity Type | Organization
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Legal Business Name | SA HEALTHCARE PHYSICIANS,LLC
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 145 ROUTE 46 W
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City | WAYNE
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State | NJ
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Zip | 07470-6830
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Country | US
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Telephone | 973-826-8287
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4059
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City | WAYNE
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State | NJ
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Zip | 07474-4059
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Country | US
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Telephone | 973-826-8287
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Fax | 973-513-6081
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. KHASHAYAR VOSOUGH
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Credential |
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Telephone | 973-826-8287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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