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General NPI Number Information
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NPI Number | 1306032693
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Entity Type | Organization
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Legal Business Name | ELECTRODIAGNOSTICS AND REHABILITATION
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 66 SYCAMORE CT
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-3112
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Country | US
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Telephone | 908-432-3845
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14
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City | GILLETTE
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State | NJ
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Zip | 07933-0014
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIMI KHATTAR
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Credential | MD
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Telephone | 908-432-3845
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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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