Provider Demographics
NPI:1366586794
Name:KAZMOUZ MEDICAL CENTER INC
Entity type:Organization
Organization Name:KAZMOUZ MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HASNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAZMOUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-742-1824
Mailing Address - Street 1:7 LEE PL
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1803
Mailing Address - Country:US
Mailing Address - Phone:973-742-1824
Mailing Address - Fax:973-742-1818
Practice Address - Street 1:7 LEE PL
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1803
Practice Address - Country:US
Practice Address - Phone:973-742-1824
Practice Address - Fax:973-742-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72031261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8914109Medicaid
NJ8914109Medicaid
NJH28340Medicare UPIN