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General NPI Number Information
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NPI Number | 1447409701
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Entity Type | Organization
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Legal Business Name | SALEH I KHADDASH MD PA
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 40 UNION AVE
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City | CLIFTON
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State | NJ
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Zip | 07011-2219
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Country | US
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Telephone | 973-546-3355
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Fax | 973-546-8501
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Provider Business Mailing Address
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Address Line | 40 UNION AVE
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City | CLIFTON
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State | NJ
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Zip | 07011-2219
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Country | US
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Telephone | 973-546-3355
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Fax | 973-546-8501
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Authorized Official
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Title or Position | OWNER
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Name | DR. SALEH I KHADDASH
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Credential | MD
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Telephone | 973-546-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MA05889500
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License Number State | NJ
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