Provider Demographics
NPI:1891783841
Name:ALI, SHARIQ (MD)
Entity Type:Individual
Prefix:
First Name:SHARIQ
Middle Name:
Last Name:ALI
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 1:201 STRYKERS RD SUITE 19 #280
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-5400
Mailing Address - Country:US
Mailing Address - Phone:908-941-0600
Mailing Address - Fax:484-786-5214
Practice Address - Street 1:2 INDUSTRIAL RD STE 3-A
Practice Address - Street 2:
Practice Address - City:ALPHA
Practice Address - State:NJ
Practice Address - Zip Code:08865-4086
Practice Address - Country:US
Practice Address - Phone:908-941-0600
Practice Address - Fax:484-786-5214
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07920200208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0076341Medicaid
NJH65800Medicare UPIN
NJ093778Medicare ID - Type Unspecified