1972868040 NPI number — DR. ALI ABADI DPM

Table of content: DR. ALI ABADI DPM (NPI 1972868040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972868040 NPI number — DR. ALI ABADI DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABADI
Provider First Name:
ALI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972868040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 LIPPINCOTT DR STE 410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053-4197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-355-0340
Provider Business Mailing Address Fax Number:
856-355-0330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 ROUTE 73 N UPPR LEVEL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08053-4524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-548-7634
Provider Business Practice Location Address Fax Number:
856-779-7563
Provider Enumeration Date:
07/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  25MD00313600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25MD00313600 . This is a "NJ. BOARD OF MEDICAL EXAMINERS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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