Provider Demographics
NPI:1619099546
Name:ABDALLAH, RAMI S (OD)
Entity Type:Individual
Prefix:DR
First Name:RAMI
Middle Name:S
Last Name:ABDALLAH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OLD HICKORY CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9647
Mailing Address - Country:US
Mailing Address - Phone:856-608-7471
Mailing Address - Fax:
Practice Address - Street 1:1477 BLACKWOOD CLEMENTON RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-5729
Practice Address - Country:US
Practice Address - Phone:856-228-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00536200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJAB796083OtherMEDICARE