Healthcare Provider Details

I. General information

NPI: 1376163402
Provider Name (Legal Business Name): RAYYAN ALAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HANOVER RD STE 240
FLORHAM PARK NJ
07932-1508
US

IV. Provider business mailing address

10 CRANFORD RD
PLAINVIEW NY
11803-4004
US

V. Phone/Fax

Practice location:
  • Phone: 973-360-1100
  • Fax: 973-360-1101
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI03012100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: