Provider Demographics
NPI:1437244852
Name:PHAN, AU (MD)
Entity Type:Individual
Prefix:DR
First Name:AU
Middle Name:
Last Name:PHAN
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 1:3185 RT. 27
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1313
Mailing Address - Country:US
Mailing Address - Phone:732-422-4889
Mailing Address - Fax:732-940-8724
Practice Address - Street 1:3185 RT. 27
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1313
Practice Address - Country:US
Practice Address - Phone:732-422-4889
Practice Address - Fax:732-940-8724
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07199500207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8838402Medicaid
NJ8838402Medicaid
NJH50971Medicare UPIN