| Carend Provider Group Of New Jersey Pc | |
|
101 Eisenhower Pkwy Ste 300 Pmb 3146 Roseland NJ 07068-0706 | |
| (708) 872-7108 | |
| Not Available |
| Full Name | Carend Provider Group Of New Jersey Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 101 Eisenhower Pkwy Ste 300, Roseland, New Jersey |
| Authorized Official Name and Position | Awss Zidan (PRESIDENT) |
| Authorized Official Contact | 4155345527 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carend Provider Group Of New Jersey Pc 2045 W Grand Ave Ste B Pmb 89496 Chicago IL 60612 Ph: (708) 872-7108 | Carend Provider Group Of New Jersey Pc 101 Eisenhower Pkwy Ste 300 Pmb 3146 Roseland NJ 07068-0706 Ph: (708) 872-7108 |
| NPI Number | 1891410494 |
|---|---|
| Provider Enumeration Date | 10/05/2022 |
| Last Update Date | 12/16/2022 |
| Certification Date | 12/16/2022 |
| Medicare PECOS PAC ID | 4082082789 |
|---|---|
| Medicare Enrollment ID | O20221201000334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891410494 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Theodore Tom Faber |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558372995 PECOS PAC ID: 8123117249 Enrollment ID: I20220917000008 |
| Provider Name | Jaime Hatcher Martin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1649406380 PECOS PAC ID: 6507006806 Enrollment ID: I20221226000120 |
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