=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487310447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PANTHER HEALTHCARE CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2021
-----------------------------------------------------
Last Update Date | 11/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | RT 517 VILLAGE SQUARE
-----------------------------------------------------
City | ALLAMUCHY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-852-8818
-----------------------------------------------------
Fax | 908-852-8775
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 399
-----------------------------------------------------
City | ALLAMUCHY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07820-0399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-852-8818
-----------------------------------------------------
Fax | 908-852-8775
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | NADEAR HASSAN
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 908-852-8818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------