Healthcare Provider Details

I. General information

NPI: 1598020067
Provider Name (Legal Business Name): HAIDER MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PRIME PT STE 2H
PEACHTREE CITY GA
30269-3334
US

IV. Provider business mailing address

1050 WALL ST W STE 360
LYNDHURST NJ
07071-3604
US

V. Phone/Fax

Practice location:
  • Phone: 770-542-7636
  • Fax:
Mailing address:
  • Phone: 201-821-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SYED A. HAIDER
Title or Position: CEO
Credential: MD
Phone: 770-542-7636