1881041192 NPI number — SHOMAF NAKHJO, D.O. LLC

Table of content: (NPI 1881041192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881041192 NPI number — SHOMAF NAKHJO, D.O. LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHOMAF NAKHJO, D.O. LLC
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:
1881041192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 S PARK PL
Provider Second Line Business Mailing Address:
#302
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07960-3924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-490-0036
Provider Business Mailing Address Fax Number:
908-490-0067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07860-9604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-490-0036
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
NAKHJO
Authorized Official First Name:
SHOMAF
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
908-490-0036

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  25MB08739300 , 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: 1184831406 . This is a "PERSONAL NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com