Healthcare Provider Details

I. General information

NPI: 1669788543
Provider Name (Legal Business Name): ALHAKA AMID HUFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 S MUNN AVENUE
EAST ORANGE NJ
07018
US

IV. Provider business mailing address

138 S MUNN AVE
EAST ORANGE NJ
07018-2718
US

V. Phone/Fax

Practice location:
  • Phone: 973-634-5280
  • Fax: 973-404-8529
Mailing address:
  • Phone: 973-634-5280
  • Fax: 973-404-8529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberH91220236102792
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: