1063698959 NPI number — NAIM T NAZHA MD PC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063698959 NPI number — NAIM T NAZHA MD PC

Employer Identification Number (EIN):

Provider Organization Name:

NAIM T NAZHA MD PC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

NAZHA CANCER CENTER RADIATION DIVISION

Provider Other Organization Name Type Code:

3

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1063698959

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

09/16/2009

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

411 NEW RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

NORTHFIELD

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

08225-1648

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

609-383-6033

Provider Business Mailing Address Fax Number:

609-383-1548

Provider First Line Business Practice Location Address:

801 NEW ROAD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

NORTHFIELD

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08225-1648

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

609-407-5055

Provider Business Practice Location Address Fax Number:

609-407-5056

Provider Enumeration Date:

01/10/2008

Authorized Official Last Name:

NAZHA

Authorized Official First Name:

NAIM

Authorized Official Middle Name:

TOUFIC

Authorized Official Title or Position:

MD

Authorized Official Telephone Number:

609-383-6033

• Taxonomy code: 207RH0003X , with the licence number:  25MA04569800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085B0100X , with the licence number: 24179 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085N0904X , with the licence number: 24179 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0001X , with the licence number: 25MA04569800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2085R0202X , with the licence number: 24179 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QR0200X , with the licence number: 24179 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 52753001 . This is a "DMERC NJ MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0013749 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 0057805 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".