Provider Demographics
NPI:1407034879
Name:DR K A ZIYAAUDHIN, PA
Entity Type:Organization
Organization Name:DR K A ZIYAAUDHIN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAPPUKALAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZIYAAUDHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-623-9011
Mailing Address - Street 1:186 W MARKET ST
Mailing Address - Street 2:SUITE 211A
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2783
Mailing Address - Country:US
Mailing Address - Phone:973-623-9011
Mailing Address - Fax:973-624-1208
Practice Address - Street 1:186 W MARKET ST
Practice Address - Street 2:SUITE 211A
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2783
Practice Address - Country:US
Practice Address - Phone:973-623-9011
Practice Address - Fax:973-624-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03218600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3035506Medicaid
E54108Medicare UPIN