Provider Demographics
NPI:1275562472
Name:ALIZADE, AZER (MD)
Entity Type:Individual
Prefix:
First Name:AZER
Middle Name:
Last Name:ALIZADE
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 1:300 PROSPECT AVE
Mailing Address - Street 2:APT # 2A
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7712
Mailing Address - Country:US
Mailing Address - Phone:201-880-6305
Mailing Address - Fax:201-880-6305
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1914
Practice Address - Country:US
Practice Address - Phone:201-996-2755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07348900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H66382Medicare UPIN
NJ092662Medicare ID - Type Unspecified