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General NPI Number Information
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NPI Number | 1699341784
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Entity Type | Organization
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Legal Business Name | PRECIOUS PERINATOLOGY LLC
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Dates
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Enumeration Date | 05/31/2021
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 367 HYATT ST
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City | AVENEL
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State | NJ
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Zip | 07001-1159
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Country | US
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Telephone | 732-444-4646
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 SAINT GEORGES AVE STE 200A
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City | AVENEL
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State | NJ
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Zip | 07001-1330
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Country | US
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Telephone | 201-407-6222
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FARDOSE RANA
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Credential | MSC, RDMS
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Telephone | 201-407-6222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number |
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License Number State |
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