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General NPI Number Information
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NPI Number | 1932995230
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Entity Type | Organization
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Legal Business Name | FREDDIE USA OF NEW JERSEY PC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 13331 NACOGDOCHES RD
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City | SAN ANTONIO
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State | TX
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Zip | 78217
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Country | US
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Telephone | 423-275-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 180 TALMADGE RD UNIT #312
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City | EDISON
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State | NJ
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Zip | 08817
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEX MOHSENI
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Credential |
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Telephone | 301-706-4461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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