Healthcare Provider Details

I. General information

NPI: 1821320276
Provider Name (Legal Business Name): KHALID M AZIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 LINCOLN HWY
EDISON NJ
08817-3372
US

IV. Provider business mailing address

2090 LINCOLN HWY
EDISON NJ
08817-3372
US

V. Phone/Fax

Practice location:
  • Phone: 732-662-5650
  • Fax: 732-662-5651
Mailing address:
  • Phone: 732-662-5650
  • Fax: 732-662-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD15520
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08727300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: