Organization Active NPI

Ahkami Medical Group

  • Specialist
  • Passaic, NJ
National Provider Identifier
1295857365
Registry record updated Dec 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
AHKAMI MEDICAL GROUP
Practice address
110 Passaic Ave
Passaic, NJ 07055-4827
Phone
(973) 471-9585
Fax
(973) 471-8534
NPI assigned
Apr 6, 2007
Last updated
Dec 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shahrokh Stanchak, M.D.
Title
Credentialing Coordinator
Phone
(974) 471-9585

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

110 Passaic Ave
Passaic, NJ 07055-4827

Mailing address

110 Passaic Ave
Passaic, NJ 07055-4827
Phone (973) 471-9585

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090604000037 NJ Part B Supplier - Clinic/Group Practice 8729138243 Receives reassigned benefits from 1 practitioner
Practice locations: Passaic, NJ; W Paterson, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261094400000",
    "number": "1295857365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 PASSAIC AVE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554827",
            "telephone_number": "973-471-9585",
            "fax_number": "973-471-8534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 PASSAIC AVE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554827",
            "telephone_number": "973-471-9585",
            "fax_number": "973-471-8534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AHKAMI MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2009-12-18",
        "status": "A",
        "authorized_official_last_name": "STANCHAK",
        "authorized_official_first_name": "SHAHROKH",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "974-471-9585",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Passaic, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.