Provider Demographics
NPI:1144886441
Name:ABBASSI, ISLAM
Entity type:Individual
Prefix:
First Name:ISLAM
Middle Name:
Last Name:ABBASSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BATTLE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-1621
Mailing Address - Country:US
Mailing Address - Phone:201-895-2176
Mailing Address - Fax:
Practice Address - Street 1:1405 ROUTE 18 STE 105
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3744
Practice Address - Country:US
Practice Address - Phone:732-679-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00368600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery