Healthcare Provider Details

I. General information

NPI: 1295418648
Provider Name (Legal Business Name): ABDALLAH ZIDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 DERBY DR
GLASSBORO NJ
08028-2060
US

IV. Provider business mailing address

22 DERBY DR
GLASSBORO NJ
08028-2060
US

V. Phone/Fax

Practice location:
  • Phone: 845-453-4639
  • Fax:
Mailing address:
  • Phone: 845-453-4639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA7-0012588
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: