Healthcare Provider Details

I. General information

NPI: 1891954947
Provider Name (Legal Business Name): COMBIZ REZAYAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 BROAD ST
CLIFTON NJ
07013-4236
US

IV. Provider business mailing address

433 CENTRAL AVE
WESTFIELD NJ
07090-2520
US

V. Phone/Fax

Practice location:
  • Phone: 973-759-9000
  • Fax: 973-759-1507
Mailing address:
  • Phone: 973-759-9000
  • Fax: 973-759-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number240912
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA08728500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: