Individual
DIANA KHAITOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1 CLARA MAASS DR, CLARA MAASS MEDICAL CENTER, BELLEVILLE, NJ 07109-3550
(973) 450-2000
(973) 251-1109
Mailing address
PO BOX 717, LIVINGSTON, NJ 07039-0717
(800) 345-0064
(973) 251-1109
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00183400
NJ
Other
Enumeration date
03/24/2010
Last updated
03/24/2010
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