Basic Information
| Provider Information | |||||||||
| NPI: | 1356303044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AZIZ | ||||||||
| FirstName: | SHAHID | ||||||||
| MiddleName: | RAHIM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.M.D., M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 ROUTE 66 FL 3 | ||||||||
| Address2: | |||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077532645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328070877 | ||||||||
| FaxNumber: | 2017511680 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 BERGEN ST | ||||||||
| Address2: | ROOM B854 | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739724292 | ||||||||
| FaxNumber: | 9739727322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 05/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | DI218860 | NJ | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 204E00000X | 25MA07730100 | NJ | Y | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery |
No ID Information.