=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649415779
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAZNIN A-RAHIM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2008
-----------------------------------------------------
Last Update Date | 12/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 RAILROAD AVE
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-873-7600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 54 HUNTLEY WAY
-----------------------------------------------------
City | BRIDGEWATER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08807-5565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-725-2571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 41YS00238700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------