Provider Demographics
NPI:1952385692
Name:FAYYAZ, IMRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:
Last Name:FAYYAZ
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 1:2107 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3403
Mailing Address - Country:US
Mailing Address - Phone:609-586-1319
Mailing Address - Fax:609-586-1468
Practice Address - Street 1:2107 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3403
Practice Address - Country:US
Practice Address - Phone:609-586-1319
Practice Address - Fax:609-586-1468
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260631207RG0100X
NJ25MA06926000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2150009000OtherAMERIHEALTH HMO
NJ9303718-002OtherCIGNA
NJ2401109OtherGHI
NJ2K2723OtherHEALTHNET
NJ0007528230001OtherONE HEALTH PLAN
NJ2959308OtherAETNA HMO
NJ7204313OtherAETNA PPO
NJ88151OtherLOCAL 825 PPO
NJ8856605Medicaid
NJP2646425OtherOXFORD
NJ1465716OtherAMERIHEALTH PPO
NJ222233588OtherHORIZON BC/BS
NJ103482OtherAMERICAID
NJ2124512OtherFIRST HEALTH
NJ163917OtherCHN
NJ222233588OtherPHCS
NJFA057348Medicare PIN
NJ2K2723OtherHEALTHNET