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General NPI Number Information
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NPI Number | 1255868956
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Entity Type | Organization
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Legal Business Name | ALI R. SURAHIO
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Dates
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Enumeration Date | 05/12/2017
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 10 SHAWNEE DR SUITE B2
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City | WATCHUNG
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State | NJ
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Zip | 07069-5803
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Country | US
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Telephone | 917-932-3433
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Fax |
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Provider Business Mailing Address
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Address Line | 306 W MORRIS AVE APARTMENT 2
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City | LINDEN
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State | NJ
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Zip | 07036-4376
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD/PSYCHIATRIST
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Name | DR. ALI R. SURAHIO
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Credential | M.D.
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Telephone | 917-932-3433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 25MA09574700
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License Number State | NJ
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