Healthcare Provider Details

I. General information

NPI: 1114293289
Provider Name (Legal Business Name): ALI SEYAR RAHYAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 KLOCKNER RD
HAMILTON NJ
08690-3414
US

IV. Provider business mailing address

2073 KLOCKNER RD
HAMILTON NJ
08690-3414
US

V. Phone/Fax

Practice location:
  • Phone: 609-584-1212
  • Fax: 609-584-0103
Mailing address:
  • Phone: 609-584-1212
  • Fax: 609-584-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA10514900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: