Healthcare Provider Details

I. General information

NPI: 1093763039
Provider Name (Legal Business Name): EYAD Y BAGHAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EYAD Y BAGHAL MD

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HALEDON AVE
PROSPECT PARK NJ
07508-2051
US

IV. Provider business mailing address

160 HALEDON AVE
PROSPECT PARK NJ
07508-2051
US

V. Phone/Fax

Practice location:
  • Phone: 973-782-4871
  • Fax: 973-782-4873
Mailing address:
  • Phone: 973-782-4871
  • Fax: 973-782-4873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number62757
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: