Basic Information
| Provider Information | |||||||||
| NPI: | 1760814867 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAYNE TMS INSTITUTE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 HAMBURG TPKE STE 302 | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074702139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737909222 | ||||||||
| FaxNumber: | 9737900671 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 HAMBURG TPKE STE 302 | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074702139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737909222 | ||||||||
| FaxNumber: | 9737900671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2013 | ||||||||
| LastUpdateDate: | 07/31/2013 | ||||||||
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| AuthorizedOfficialLastName: | ELRAFEI | ||||||||
| AuthorizedOfficialFirstName: | MOHAMED | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9737909222 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 25MA08679700 | NJ | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 25MA05085700 | NJ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.