Provider Demographics
NPI:1003307372
Name:ALZUBAIDI, MOHANAD (MD, CSA, CSFA)
Entity Type:Individual
Prefix:
First Name:MOHANAD
Middle Name:
Last Name:ALZUBAIDI
Suffix:
Gender:M
Credentials:MD, CSA, CSFA
Other - Prefix:
Other - First Name:NA
Other - Middle Name:
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, CSA, CSFA
Mailing Address - Street 1:16 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4225
Mailing Address - Country:US
Mailing Address - Phone:832-833-9643
Mailing Address - Fax:
Practice Address - Street 1:16 HOLLY LN
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4225
Practice Address - Country:US
Practice Address - Phone:832-833-9643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17-572246ZC0007X
NJNJDCATEMP-002299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant