Active NPI
Women'S Pelvic Surgery of North Jersey, LLC
- Medical Specialty Clinic/Center
- Paramus, NJ
National Provider Identifier
1417243197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Specialty Clinic/Center
- License
- 25MA08288700
- Legal business name
- WOMEN'S PELVIC SURGERY OF NORTH JERSEY, LLC
- Practice address
- 1 Kalisa Way Ste 103
Paramus, NJ 07652-3508 - Phone
- (201) 301-2772
- Fax
- (201) 882-8422
- NPI assigned
- Jun 22, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Khashayar Shakiba, M.D.
- Title
- Director
- Phone
- (201) 301-2772
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Specialty Clinic/Center | 261QM2500X | 25MA08288700 | NJ | Primary |
Addresses
Primary practice location
1 Kalisa Way Ste 103
Paramus, NJ 07652-3508
Mailing address
PO Box 666
Ridgewood, NJ 07451-0666
Phone (201) 301-2772
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Women Pelvic Surgery of North Jersey LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Obstetrics & Gynecology Physician
- Wayne, NJ
- NPI 1578875266
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Obstetrics & Gynecology Physician
- Paramus, NJ
- NPI 1114121571
-
- Obstetrics & Gynecology Physician
- Hackensack, NJ
- NPI 1023513678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308700800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1308700800000",
"number": "1417243197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 666",
"city": "RIDGEWOOD",
"state": "NJ",
"postal_code": "074510666",
"telephone_number": "201-301-2772",
"fax_number": "201-882-8422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 KALISA WAY STE 103",
"city": "PARAMUS",
"state": "NJ",
"postal_code": "076523508",
"telephone_number": "201-301-2772",
"fax_number": "201-882-8422"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WOMEN'S PELVIC SURGERY OF NORTH JERSEY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2011-06-22",
"last_updated": "2011-06-22",
"status": "A",
"authorized_official_last_name": "SHAKIBA",
"authorized_official_first_name": "KHASHAYAR",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "201-301-2772",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "261QM2500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Medical Specialty",
"state": "NJ",
"license": "25MA08288700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paramus, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2011; 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.