Provider Demographics
NPI:1184035693
Name:JON, ALI FARZAN (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:FARZAN
Last Name:JON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
Mailing Address - Street 2:150 BERGEN STREET UH C 318 A
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-1709
Mailing Address - Country:US
Mailing Address - Phone:973-972-6025
Mailing Address - Fax:
Practice Address - Street 1:RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
Practice Address - Street 2:150 BERGEN STREET UH C 318 A DEPARTMENT OF RADIOLOGY
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07101-1709
Practice Address - Country:US
Practice Address - Phone:973-972-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA2846832085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program