Provider Demographics
NPI:1407965775
Name:BARI, FAZAL (MD)
Entity Type:Individual
Prefix:
First Name:FAZAL
Middle Name:
Last Name:BARI
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 1:333 ROUTE 46 WEST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1723
Mailing Address - Country:US
Mailing Address - Phone:973-316-1701
Mailing Address - Fax:973-316-1708
Practice Address - Street 1:333 ROUTE 46 W
Practice Address - Street 2:
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1743
Practice Address - Country:US
Practice Address - Phone:973-316-1701
Practice Address - Fax:973-316-1708
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA69609207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8227900Medicaid
NJH01767Medicare UPIN
NJ8227900Medicaid