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General NPI Number Information
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NPI Number | 1285459644
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Entity Type | Individual
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Provider Name | EMAD M KHELLA
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Gender | Male
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 15 COMMERCE BLVD STE 100
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City | SUCCASUNNA
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State | NJ
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Zip | 07876-1343
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Country | US
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Telephone | 973-587-6404
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Fax |
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Provider Business Mailing Address
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Address Line | 463 OLD POST RD APT 202
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City | EDISON
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State | NJ
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Zip | 08817-4693
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Country | US
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Telephone | 551-221-4933
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15216300
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License Number State | NJ
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