Provider Demographics
NPI:1255009361
Name:PARACHA, ALI SAJJAD
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:SAJJAD
Last Name:PARACHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 JONES ST APT 427
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-3844
Mailing Address - Country:US
Mailing Address - Phone:917-689-2525
Mailing Address - Fax:
Practice Address - Street 1:24 JONES ST APT 427
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3844
Practice Address - Country:US
Practice Address - Phone:917-689-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0401417713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program