Organization Active NPI

Nami Khulusi MD LLC

  • Internal Medicine Physician
  • Englishtown, NJ
National Provider Identifier
1417092776
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA06313900 Issued in NJ
Legal business name
NAMI KHULUSI MD LLC
Practice address
74 US Highway 9
Englishtown, NJ 07726-9209
Phone
(718) 819-2920
Fax
(718) 819-2923
NPI assigned
Feb 21, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Eileen Kenny
Title
Off. MGR.
Phone
(718) 819-2920

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 25MA06313900 NJ Primary

Addresses

Primary practice location

74 US Highway 9
Englishtown, NJ 07726-9209

Mailing address

74 Route 9 North
Englishtown, NJ 07726
Phone (718) 819-2920

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070223000281 NJ Part B Supplier - Clinic/Group Practice 1759483654 Receives reassigned benefits from 1 practitioner
Practice locations: Eatontown, NJ; Long Branch, NJ

National Provider Directory

National Provider Directory

Locations

615 Hope Rd
Ste 2A
Eatontown, NJ 07724
Phone (732) 233-6448

74 Route 9
Lowr
Englishtown, NJ 07726
Phone (732) 972-5880

Practitioners & affiliated clinicians

Practitioners 5

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": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417092776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 ROUTE 9 NORTH",
            "city": "ENGLISHTOWN",
            "state": "NJ",
            "postal_code": "07726",
            "telephone_number": "718-819-2920",
            "fax_number": "718-819-2923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 US HIGHWAY 9",
            "city": "ENGLISHTOWN",
            "state": "NJ",
            "postal_code": "077269209",
            "telephone_number": "718-819-2920",
            "fax_number": "718-819-2923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NAMI KHULUSI MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KENNY",
        "authorized_official_first_name": "EILEEN",
        "authorized_official_title_or_position": "OFF. MGR.",
        "authorized_official_telephone_number": "718-819-2920"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA06313900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Englishtown, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.