Healthcare Provider Details

I. General information

NPI: 1518301506
Provider Name (Legal Business Name): AHMED MOHAMED REZK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 ROUTE 66 FL 4
NEPTUNE NJ
07753-2645
US

IV. Provider business mailing address

3600 ROUTE 66 FL 4
NEPTUNE NJ
07753-2645
US

V. Phone/Fax

Practice location:
  • Phone: 732-571-1000
  • Fax: 732-571-1156
Mailing address:
  • Phone: 732-571-1000
  • Fax: 732-571-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB10952500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: