Provider Demographics
NPI:1548488968
Name:AMMAR BAZERBASHI
Entity type:Organization
Organization Name:AMMAR BAZERBASHI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZERBASHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-888-0017
Mailing Address - Street 1:668 N BEERS ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1511
Mailing Address - Country:US
Mailing Address - Phone:732-888-0017
Mailing Address - Fax:732-888-0097
Practice Address - Street 1:668 N BEERS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1511
Practice Address - Country:US
Practice Address - Phone:732-888-0017
Practice Address - Fax:732-888-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72160173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100357Medicare ID - Type Unspecified
NJH33778Medicare UPIN