Provider Demographics
NPI:1972615078
Name:KASHOQA, AMER H (MD)
Entity type:Individual
Prefix:
First Name:AMER
Middle Name:H
Last Name:KASHOQA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 HAMBURG TPKE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2068
Mailing Address - Country:US
Mailing Address - Phone:973-633-1996
Mailing Address - Fax:973-633-8078
Practice Address - Street 1:506 HAMBURG TPKE
Practice Address - Street 2:SUITE 203
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2069
Practice Address - Country:US
Practice Address - Phone:973-633-1996
Practice Address - Fax:973-633-8078
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA057427002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5524504Medicaid
NJ005629YFBMMedicare PIN
NJ5524504Medicaid