Provider Demographics
NPI:1457391310
Name:AZIZ, REHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:REHAN
Middle Name:
Last Name:AZIZ
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 829642
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-9642
Mailing Address - Country:US
Mailing Address - Phone:866-470-6626
Mailing Address - Fax:413-599-0470
Practice Address - Street 1:125 PATERSON ST STE 6100
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1962
Practice Address - Country:US
Practice Address - Phone:732-235-7647
Practice Address - Fax:732-235-7767
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0435792084P0800X, 2084P0805X
NJ25MA098272002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001435791Medicaid
CT260004885OtherMEDICARE PTAN
CT35960OtherCONTROLLED SUBSTANCE REG.
CT06-1483276OtherGROUP TAX ID.
CT001435793Medicaid
CTC02270OtherGROUP MEDICARE ID.
CT260004885Medicare PIN
CTC02270OtherGROUP MEDICARE ID.
CT001435791Medicaid