Healthcare Provider Details

I. General information

NPI: 1205280641
Provider Name (Legal Business Name): MAYCE HAJ-ALI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 ROUTE 22 STE 155
BRIDGEWATER NJ
08807-2939
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 732-667-1123
  • Fax: 732-560-3206
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA11062400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: