Healthcare Provider Details

I. General information

NPI: 1588912844
Provider Name (Legal Business Name): AHMED HASAN AL-KHAZRAJI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 06/25/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652
US

IV. Provider business mailing address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-4000
  • Fax:
Mailing address:
  • Phone: 201-967-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA11377500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: