Provider Demographics
NPI:1881623171
Name:AMAL W. AZER, M.D.
Entity type:Organization
Organization Name:AMAL W. AZER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMAL
Authorized Official - Middle Name:W
Authorized Official - Last Name:AZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-888-2086
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 1:301 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-1554
Practice Address - Country:US
Practice Address - Phone:908-601-8805
Practice Address - Fax:732-888-1608
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMAL W. AZER, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-01
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA063227208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG19947Medicare UPIN
NJ055482Medicare ID - Type UnspecifiedMEDICARE GROUP ID #