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General NPI Number Information
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NPI Number | 1124055116
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Entity Type | Individual
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Provider Name | MORTEZA KHALADJ PODIATRIST DP.M.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 9 LAMINGTON RD
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City | BRANCHBURG
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State | NJ
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Zip | 08876
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Country | US
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Telephone | 908-625-1042
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Fax | 908-355-4400
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Provider Business Mailing Address
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Address Line | 21 VALLEY VIEW AVE
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City | GLADSTONE
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State | NJ
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Zip | 07934
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Country | US
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Telephone | 908-625-1042
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Fax | 908-355-4400
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00179900
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License Number State | NJ
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