Healthcare Provider Details

I. General information

NPI: 1053332965
Provider Name (Legal Business Name): IMAD M ARIDI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 W JIMMIE LEEDS RD 76 WEST PARK CENTRE SUITE 301
GALLOWAY NJ
08205-9411
US

IV. Provider business mailing address

76 W JIMMIE LEEDS RD 76 WEST PARK CENTRE SUITE 301
GALLOWAY NJ
08205-9411
US

V. Phone/Fax

Practice location:
  • Phone: 609-652-9111
  • Fax: 609-652-1283
Mailing address:
  • Phone: 609-652-9111
  • Fax: 609-652-1283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA04727700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA04727700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA04727700
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA04727700
License Number StateNJ

VIII. Authorized Official

Name: IMAD ARIDI
Title or Position: OWNER
Credential: M.D.
Phone: 609-652-9111