Basic Information
Provider Information
NPI: 1407351638
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALAM
FirstName: LOBA
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 DIAMOND HILL RD
Address2:  
City: BERKELEY HEIGHTS
State: NJ
PostalCode: 079222104
CountryCode: US
TelephoneNumber: 9082734300
FaxNumber:  
Practice Location
Address1: 99 BEAUVOIR AVE
Address2:  
City: SUMMIT
State: NJ
PostalCode: 079013533
CountryCode: US
TelephoneNumber: 9085222000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/29/2018
LastUpdateDate: 03/14/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/14/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X314652NYN Allopathic & Osteopathic PhysiciansHospitalist 
208M00000X25MA11061300NJY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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