Provider Demographics
NPI:1063572147
Name:OBGYN AND INFERTILITY SERVICES OF NORTHERN NEW JERSEY LLC
Entity type:Organization
Organization Name:OBGYN AND INFERTILITY SERVICES OF NORTHERN NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-471-0707
Mailing Address - Street 1:721 CLIFTON AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1880
Mailing Address - Country:US
Mailing Address - Phone:973-471-0707
Mailing Address - Fax:973-471-2112
Practice Address - Street 1:721 CLIFTON AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1880
Practice Address - Country:US
Practice Address - Phone:973-471-0707
Practice Address - Fax:973-471-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07473700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ121537Medicare PIN