MEDICARE: DR. REHAN ALI M.D.

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	25MA09668500	NJ
2	208VP0014X	Interventional Pain Medicine Physician	25MA09668500	NJ

General Provider Information

NPI Number	:	1144527011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REHAN ALI M.D.

Provider Business Mailing Address
First Line	:	328 MERCER LOOP
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-3233
Country	:	US
Telephone Number	:	201-936-7712
Fax Number	:

Provider Business Practice Location Address
First Line	:	1144 E RIDGEWOOD AVE FL 2
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3941
Country	:	US
Telephone Number	:	201-336-0188
Fax Number	:	201-336-0141

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

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	01/24/2024

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