Provider Demographics
NPI:1366562902
Name:FAISAL, KHAJA TAJUDDIN (MD)
Entity type:Individual
Prefix:
First Name:KHAJA
Middle Name:TAJUDDIN
Last Name:FAISAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CLOCKTOWER DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3010
Mailing Address - Country:US
Mailing Address - Phone:609-683-3283
Mailing Address - Fax:609-683-3291
Practice Address - Street 1:300 CLOCKTOWER DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3010
Practice Address - Country:US
Practice Address - Phone:609-683-3283
Practice Address - Fax:609-683-3291
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA082154002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0181463Medicaid
NJ0181463Medicaid
NJ117962ZGA2Medicare PIN