Provider Demographics
NPI:1497738801
Name:SECKIN, ALI INANC (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:INANC
Last Name:SECKIN
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:PO BOX 18914
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07191-8914
Mailing Address - Country:US
Mailing Address - Phone:201-488-0066
Mailing Address - Fax:201-488-6769
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1914
Practice Address - Country:US
Practice Address - Phone:201-488-0066
Practice Address - Fax:201-488-6769
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07745200207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0071838Medicaid
NY02645105Medicaid
P00265560OtherRAILROAD MEDICARE
NJ0071838Medicaid
NJ092991A13Medicare PIN