Healthcare Provider Details

I. General information

NPI: 1114546355
Provider Name (Legal Business Name): WERDA ALAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DIAMOND HILL RD
BERKELEY HEIGHTS NJ
07922-2104
US

IV. Provider business mailing address

2390 DENTON ST
NORTH BELLMORE NY
11710-2725
US

V. Phone/Fax

Practice location:
  • Phone: 908-277-8640
  • Fax: 908-673-7241
Mailing address:
  • Phone: 516-710-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA12154000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: