Healthcare Provider Details

I. General information

NPI: 1073778429
Provider Name (Legal Business Name): HAMID M NIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 615
HACKENSACK NJ
07601-1989
US

IV. Provider business mailing address

PO BOX 1513
PARAMUS NJ
07653-1513
US

V. Phone/Fax

Practice location:
  • Phone: 201-265-5700
  • Fax: 551-996-0774
Mailing address:
  • Phone: 973-919-2806
  • Fax: 551-996-0774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07844400
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier25MA07844400
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMEDICAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: