Healthcare Provider Details

I. General information

NPI: 1679601348
Provider Name (Legal Business Name): ALI ZOMORODI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 OMNI DR
HILLSBOROUGH NJ
08844-4527
US

IV. Provider business mailing address

407 OMNI DR
HILLSBOROUGH NJ
08844-4527
US

V. Phone/Fax

Practice location:
  • Phone: 908-359-3779
  • Fax: 908-359-5356
Mailing address:
  • Phone: 908-359-3779
  • Fax: 908-359-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA03024600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: