Provider Demographics
NPI:1932995230
Name:FREDDIE USA OF NEW JERSEY PC
Entity type:Organization
Organization Name:FREDDIE USA OF NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHSENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-706-4461
Mailing Address - Street 1:180 TALMADGE RD
Mailing Address - Street 2:UNIT #312
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13331 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217
Practice Address - Country:US
Practice Address - Phone:423-275-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health