Healthcare Provider Details

I. General information

NPI: 1760432215
Provider Name (Legal Business Name): IMAD M ARIDI MD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/19/2007
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: 609-652-2555
  • Fax: 609-652-1283
Mailing address:
  • Phone: 609-652-2555
  • 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 TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA04727700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA04727700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA04727700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: