Provider Demographics
NPI:1649249509
Name:AL-SHROUF, AMAL A (MD)
Entity type:Individual
Prefix:DR
First Name:AMAL
Middle Name:A
Last Name:AL-SHROUF
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 1:355 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-3642
Mailing Address - Country:US
Mailing Address - Phone:973-523-9090
Mailing Address - Fax:973-523-5222
Practice Address - Street 1:355 21ST AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-3642
Practice Address - Country:US
Practice Address - Phone:973-523-9090
Practice Address - Fax:973-523-5222
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA075034207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0009393Medicaid
NJ069430Medicare ID - Type Unspecified
NJ0009393Medicaid