Provider Demographics
NPI:1588997738
Name:MATAWAN ABERDEEN HEART & MEDICAL CENTER
Entity type:Organization
Organization Name:MATAWAN ABERDEEN HEART & MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FAZAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PANEZAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-566-6614
Mailing Address - Street 1:177 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-4107
Mailing Address - Country:US
Mailing Address - Phone:732-566-6614
Mailing Address - Fax:732-290-9448
Practice Address - Street 1:177 MAIN ST
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-4107
Practice Address - Country:US
Practice Address - Phone:732-566-6614
Practice Address - Fax:732-290-9448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA33492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2066602-22Medicaid
NJJ1397OtherHORIZON BLUE CROSS BLUE SHIEL
NJ404118Medicare PIN
NJ2066602-22Medicaid
NJ404118Medicare Oscar/Certification