MEDICARE: DR. ALI RAZA ESMAIL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	25MA09857200	NJ
2	207YS0123X	Facial Plastic Surgery Physician	25MA09857200	NJ

General Provider Information

NPI Number	:	1134673502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI RAZA ESMAIL MD

Provider Business Mailing Address
First Line	:	1 SPRING ST
Second Line	:	2304
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901
Country	:	US
Telephone Number	:	609-906-3551
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SPRING ST
Second Line	:	2304
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-2276
Country	:	US
Telephone Number	:	609-906-3551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2016
Last Update Date	:	08/15/2016

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