Healthcare Provider Details

I. General information

NPI: 1194151019
Provider Name (Legal Business Name): ABBASI MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MAIN AVE APT 2D
CLIFTON NJ
07011-2266
US

IV. Provider business mailing address

57 BENSAM PL
NORTH HALEDON NJ
07508-3068
US

V. Phone/Fax

Practice location:
  • Phone: 973-851-7818
  • Fax: 201-595-0290
Mailing address:
  • Phone: 201-766-1541
  • Fax: 201-595-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA05862000
License Number StateNJ

VIII. Authorized Official

Name: DR. TAREEF ABBASI
Title or Position: DOCTOR/OWNER
Credential: MD
Phone: 201-766-1541