Healthcare Provider Details

I. General information

NPI: 1548488968
Provider Name (Legal Business Name): AMMAR BAZERBASHI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
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 NumberMA72160
License Number StateNJ

VIII. Authorized Official

Name: AMMAR BAZERBASHI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 732-888-0017