1619910932 NPI number — KHALAF RABADI, M.D., P.C.

Table of content: (NPI 1619910932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619910932 NPI number — KHALAF RABADI, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KHALAF RABADI, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1619910932
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2119 KLOCKNER RD
Provider Second Line Business Mailing Address:
BUILDING 8, SUITE 34
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08690-3417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-586-6500
Provider Business Mailing Address Fax Number:
609-586-8694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2119 KLOCKNER RD
Provider Second Line Business Practice Location Address:
BUILDING 8, SUITE 34
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08690-3417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-586-6500
Provider Business Practice Location Address Fax Number:
609-586-8694
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RABADI
Authorized Official First Name:
KHALAF
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
609-586-6500

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0716741001 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: PSF0604 . This is a "1ST OPTION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: MEP106 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 146654 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 554529 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0768201 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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