Provider Demographics
NPI:1235189507
Name:ALAM, ABU S (MD)
Entity Type:Individual
Prefix:DR
First Name:ABU
Middle Name:S
Last Name:ALAM
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 1:779 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2332
Mailing Address - Country:US
Mailing Address - Phone:908-273-5907
Mailing Address - Fax:908-277-2421
Practice Address - Street 1:779 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2332
Practice Address - Country:US
Practice Address - Phone:908-273-5907
Practice Address - Fax:908-277-2421
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03924300207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJOK5705OtherHEALTHNET
NJ0040292OtherAETNA HMO
NJ4220706OtherAETNA TRADITIONAL
NJ0098910000OtherAMERIHEALTH
NJUP136Medicare UPIN
NJ0040292OtherAETNA HMO