Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 22DI0226900 | NJ |
Y | 213EG0000X | General Practice | 22DI0226900 | NJ |
NPI | 1003144239 |
---|---|
Provider Name | Dr. Haleh Kossari |
First Address | Roselle Park, NJ 07204-2281 |
Second Address | Roselle Park, NJ 07204-2281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2009 |
Last Update Date | 30/11/2009 |