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NPI Code Detail

MEDICARE: MARIAM WALLIZADEH NP

MEDICARE: MARIAM WALLIZADEH NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner26NJ00978800NJ

General Provider Information

NPI Number : 1740828169
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAM WALLIZADEH NP
Provider Business Mailing Address
First Line : 331 NEWMAN SPRINGS RD
Second Line : BLDG 2, STE 220
City : RED BANK
State : NJ
Zip : 07701-5688
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2440 HAMBURG TPKE
Second Line :
City : WAYNE
State : NJ
Zip : 07470-6226
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2019
Last Update Date : 06/18/2026

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