Basic Information
| Provider Information | |||||||||
| NPI: | 1366891186 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALIHASSAN | ||||||||
| FirstName: | FAROOQ | ||||||||
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| Mailing Information | |||||||||
| Address1: | 671 HOES LN W | ||||||||
| Address2: | |||||||||
| City: | PISCATAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088548021 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 CORPORATE PL S | ||||||||
| Address2: | |||||||||
| City: | PISCATAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088546148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322354404 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2016 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 31-4011 | 01 | NJ | MEDICARE | OTHER | 4144007 | 05 | NJ | MEDICAID |