Healthcare Provider Details

I. General information

NPI: 1235923384
Provider Name (Legal Business Name): IMRAN SYED ALAM
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 S. ORANGE AVE MSB F-506
NEWARK NJ
07103
US

IV. Provider business mailing address

185 S. ORANGE AVE MSB F-506
NEWARK NJ
07103
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-5188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: