Healthcare Provider Details

I. General information

NPI: 1205885704
Provider Name (Legal Business Name): AMMAR BAZERBASHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 HWY 35
MIDDLETOWN NJ
07748-2603
US

IV. Provider business mailing address

950 HWY 35
MIDDLETOWN NJ
07748-2603
US

V. Phone/Fax

Practice location:
  • Phone: 732-888-0017
  • Fax: 732-888-0097
Mailing address:
  • Phone: 732-888-0017
  • Fax: 732-888-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA072160
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: