Provider Demographics
NPI:1629007919
Name:AZER, AMAL W (MD)
Entity Type:Individual
Prefix:
First Name:AMAL
Middle Name:W
Last Name:AZER
Suffix:
Gender:F
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 254
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-0254
Mailing Address - Country:US
Mailing Address - Phone:732-888-2086
Mailing Address - Fax:732-888-1608
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:BLDG.2 #33
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730
Practice Address - Country:US
Practice Address - Phone:732-888-2086
Practice Address - Fax:732-888-1608
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA063227208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG19947Medicare UPIN
NJ820596QC6Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #