Provider Demographics
NPI:1053332965
Name:IMAD M ARIDI MD PA
Entity Type:Organization
Organization Name:IMAD M ARIDI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-652-9111
Mailing Address - Street 1:76 W JIMMIE LEEDS RD
Mailing Address - Street 2:76 WEST PARK CENTRE SUITE 301
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9411
Mailing Address - Country:US
Mailing Address - Phone:609-652-9111
Mailing Address - Fax:609-652-1283
Practice Address - Street 1:76 W JIMMIE LEEDS RD
Practice Address - Street 2:76 WEST PARK CENTRE SUITE 301
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9411
Practice Address - Country:US
Practice Address - Phone:609-652-9111
Practice Address - Fax:609-652-1283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04727700207Q00000X, 207R00000X, 2085R0202X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0010972OtherUS HEALTHCARE
PA575019OtherPENNSYLVANIA BLUE SHIELD
NJATP016OtherOXFORD
NJOK6443OtherHEALTHNET
NJ0396670001OtherAMERIHEALTH
NJ3594700Medicaid
NJ80340OtherAMERIGROUP
NJ0396670001OtherAMERIHEALTH ADMINISTRATOR
NJ=========OtherLOCAL 54
NJ=========OtherTRICARE / CHAMPUS
NJATP016OtherOXFORD
NJ0010972OtherUS HEALTHCARE
NJ0396670001OtherAMERIHEALTH ADMINISTRATOR
NJ3594700Medicaid
NJ3594700Medicaid
NJC58176Medicare UPIN