Provider Demographics
NPI:1760432215
Name:ARIDI, IMAD M (MD PA)
Entity Type:Individual
Prefix:DR
First Name:IMAD
Middle Name:M
Last Name:ARIDI
Suffix:
Gender:M
Credentials:MD PA
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:76 W JIMMIE LEEDS RD
Mailing Address - Street 2:76 WEST PARK CENTRE, SUITE 301
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9411
Mailing Address - Country:US
Mailing Address - Phone:609-652-2555
Mailing Address - Fax:609-652-1283
Practice Address - Street 1:76 W JIMMIE LEEDS RD
Practice Address - Street 2:76 WEST PARK CENTRE, SUITE 301
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9411
Practice Address - Country:US
Practice Address - Phone:609-652-2555
Practice Address - Fax:609-652-1283
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04727700207Q00000X, 207R00000X, 2085R0202X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3594700Medicaid
NJ4727700OtherAETNA
NJATP016OtherOXFORD
NJ80340OtherAMERIGROUP
NJ0010972OtherUS HEALTHCARE
NJ0396670000OtherAMERIHEALTH
NJ0396670000OtherAMERIHEALTH ADMINISTRATOR
PA532743OtherPENNSYLVANIA BLUE SHIELD
NJOK6443OtherHEALTHNET
NJ80340OtherAMERIGROUP
PA532743OtherPENNSYLVANIA BLUE SHIELD