Healthcare Provider Details

I. General information

NPI: 1750961603
Provider Name (Legal Business Name): DR. SHAHAN ALI SYED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652-4142
US

IV. Provider business mailing address

34 N RIDGE RD
LIVINGSTON NJ
07039-1240
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-4000
  • Fax:
Mailing address:
  • Phone:
  • 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 StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA12370500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: