MEDICARE: ALI ELHABBAK

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	156FX1800X	Optician	31TD00365202	NJ

General Provider Information

NPI Number	:	1871825406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI ELHABBAK

Provider Business Mailing Address
First Line	:	1 ANDERSON AVE
Second Line	:
City	:	FAIRVIEW
State	:	NJ
Zip	:	07022-2154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 ANDERSON AVE
Second Line	:
City	:	FAIRVIEW
State	:	NJ
Zip	:	07022-2154
Country	:	US
Telephone Number	:	201-658-9692
Fax Number	:

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

Provider Enumeration Date	:	02/07/2010
Last Update Date	:	02/07/2010

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Directions to “ ALI ELHABBAK ” Practice Location

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