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General NPI Number Information
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NPI Number | 1356107916
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Entity Type | Organization
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Legal Business Name | GARDEN STATE SPECIALTY CARE, LLC
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Dates
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Enumeration Date | 02/22/2024
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 1418 NEW RD STE 2
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1179
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Country | US
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Telephone | 609-796-7969
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Fax |
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Provider Business Mailing Address
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Address Line | 1418 NEW RD STE 2
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1179
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Country | US
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Telephone | 609-642-2663
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Fax | 609-642-2663
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | AYEZA MOHSIN
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Credential |
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Telephone | 609-796-2119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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