Provider Demographics
NPI:1912353830
Name:HAMZELOU, ASHKAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ASHKAN
Middle Name:
Last Name:HAMZELOU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 E. 29TH STREET
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-5659
Mailing Address - Country:US
Mailing Address - Phone:201-858-8500
Mailing Address - Fax:
Practice Address - Street 1:29 E. 29TH STREET
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-5659
Practice Address - Country:US
Practice Address - Phone:201-858-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10761500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine