Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 25MA09539400 | NJ |
NPI | 1417544719 |
---|---|
Provider Name | Usman Ijaz |
First Address | Clifton, NJ 07013-3502 |
Second Address | Clifton, NJ 07013-3502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2020 |
Last Update Date | 22/12/2020 |