Healthcare Provider Details

I. General information

NPI: 1134673502
Provider Name (Legal Business Name): ALI RAZA ESMAIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SPRING ST 2304
NEW BRUNSWICK NJ
08901-2276
US

IV. Provider business mailing address

1 SPRING ST 2304
NEW BRUNSWICK NJ
08901
US

V. Phone/Fax

Practice location:
  • Phone: 609-906-3551
  • Fax:
Mailing address:
  • Phone: 609-906-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA09857200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number25MA09857200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: