Provider Demographics
NPI:1174649966
Name:AL HAJ, RANY SAMIR (MD)
Entity Type:Individual
Prefix:
First Name:RANY
Middle Name:SAMIR
Last Name:AL HAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RANY
Other - Middle Name:
Other - Last Name:HAJ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1500 ALLAIRE AVE
Mailing Address - Street 2:SUITE 203B
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7603
Mailing Address - Country:US
Mailing Address - Phone:732-660-0011
Mailing Address - Fax:
Practice Address - Street 1:1500 ALLAIRE AVE
Practice Address - Street 2:SUITE 203 B
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7603
Practice Address - Country:US
Practice Address - Phone:732-660-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07643300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI01475Medicare UPIN