# WOMEN'S PELVIC SURGERY OF NORTH JERSEY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417243197
- **Authorized official:** KHASHAYAR SHAKIBA M.D. (DIRECTOR)
- **Authorized official phone:** (201) 301-2772

## Contact information

- **Practice address:** 1 KALISA WAY STE 103, PARAMUS, NJ 07652-3508
- **Practice address phone:** (201) 301-2772
- **Practice address fax:** (201) 882-8422
- **Mailing address:** PO BOX 666, RIDGEWOOD, NJ 07451-0666
- **Mailing address phone:** (201) 301-2772
- **Mailing address fax:** (201) 882-8422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 25MA08288700 | NJ | Yes |

## Other

- **Enumeration date:** 06/22/2011
- **Last updated:** 06/22/2011