Healthcare Provider Details

I. General information

NPI: 1104072727
Provider Name (Legal Business Name): SYED A. RIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 ROUTE 70 E STE B
MARLTON NJ
08053
US

IV. Provider business mailing address

141 ROUTE 70 E STE B
MARLTON NJ
08053-1855
US

V. Phone/Fax

Practice location:
  • Phone: 856-596-9057
  • Fax: 856-596-0837
Mailing address:
  • Phone: 856-596-9057
  • Fax: 856-596-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number68990
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number250684
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA10015400
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number68990
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA10015400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: