Basic Information
| Provider Information | |||||||||
| NPI: | 1235140203 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VETERAN HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070525605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737363625 | ||||||||
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| Practice Location | |||||||||
| Address1: | 151 KNOLLCROFT RD | ||||||||
| Address2: | |||||||||
| City: | LYONS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079395001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086470180 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | IQBAL-HUSSAIN | ||||||||
| AuthorizedOfficialFirstName: | FARIDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ATTENDING, PSYCHIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 9086470180 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | 25MA07977700 | NJ | Y | Hospitals | Psychiatric Hospital |
No ID Information.