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General NPI Number Information
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NPI Number | 1912299777
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Entity Type | Organization
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Legal Business Name | ATHENA HEALTHCARE GROUP LLC
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 145 RTE 46 W SUITE 304
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City | WAYNE
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State | NJ
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Zip | 07470-6830
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Country | US
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Telephone | 973-826-8290
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Fax | 866-760-4555
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Provider Business Mailing Address
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Address Line | 145 RTE 46 W SUITE 304
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City | WAYNE
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State | NJ
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Zip | 07470-6830
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Country | US
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Telephone | 973-826-8290
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Fax | 866-760-4555
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Authorized Official
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Title or Position | MEMBER
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Name | DR. KHASHAYAR VOSOUGH
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Credential | MD
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Telephone | 973-826-8290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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