Healthcare Provider Details

I. General information

NPI: 1508797309
Provider Name (Legal Business Name): ISMAIL IMAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 WOODCLIFF AVE
LITTLE FALLS NJ
07424-1064
US

IV. Provider business mailing address

174 WOODCLIFF AVE
LITTLE FALLS NJ
07424-1064
US

V. Phone/Fax

Practice location:
  • Phone: 973-961-1410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: