1578667119 NPI number — DR. KAMRAN KHAZAI MD

Table of content: DR. KAMRAN KHAZAI MD (NPI 1578667119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578667119 NPI number — DR. KAMRAN KHAZAI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAZAI
Provider First Name:
KAMRAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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 Information

NPI Number:
1578667119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 WILLIAMSON ST
Provider Second Line Business Mailing Address:
SUITE 405
Provider Business Mailing Address City Name:
ELIZABETH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07202-3674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-353-5551
Provider Business Mailing Address Fax Number:
908-353-5052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 WILLIAMSON ST
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07202-3674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-353-5551
Provider Business Practice Location Address Fax Number:
908-353-5052
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA06505500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010065055NJ01 . This is a "ANTHEM HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2217632 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223832708 . This is a "NJ CARPENTERS FUND" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223832708 . This is a "QUAL CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223832708 . This is a "CONSUMER HEALTH NETWORK" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223832708 . This is a "MAGNA CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2555106 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000360102 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223832708 . This is a "BC/BS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7479271 . This is a "AETNA USHC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0299190 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 64712004 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223832708 . This is a "DEVON" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 223832708 . This is a "ONE HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223832708 . This is a "BEECH STREET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223832708 . This is a "BETTER HEALTH ADVANTAGE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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