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General NPI Number Information
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NPI Number | 1477261741
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Entity Type | Organization
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Legal Business Name | ST MARYS GENERAL MEDICAL GROUP PC
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 350 BOULEVARD
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City | PASSAIC
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State | NJ
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Zip | 07055-2840
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Country | US
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Telephone | 973-365-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 350 BOULEVARD
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City | PASSAIC
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State | NJ
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Zip | 07055-2840
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Country | US
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Telephone | 973-365-4300
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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. SYED IFTIKHAR KAZMI
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Credential | MD
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Telephone | 973-877-5308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family 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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology 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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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #5
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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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