Healthcare Provider Details

I. General information

NPI: 1255868956
Provider Name (Legal Business Name): ALI R. SURAHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SHAWNEE DR SUITE B2
WATCHUNG NJ
07069-5803
US

IV. Provider business mailing address

306 W MORRIS AVE APARTMENT 2
LINDEN NJ
07036-4376
US

V. Phone/Fax

Practice location:
  • Phone: 917-932-3433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number25MA09574700
License Number StateNJ

VIII. Authorized Official

Name: DR. ALI R. SURAHIO
Title or Position: MD/PSYCHIATRIST
Credential: M.D.
Phone: 917-932-3433