Basic Information
| Provider Information | |||||||||
| NPI: | 1457391310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AZIZ | ||||||||
| FirstName: | REHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 829642 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191829642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664706626 | ||||||||
| FaxNumber: | 4135990470 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 PATERSON ST STE 6100 | ||||||||
| Address2: | |||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322357647 | ||||||||
| FaxNumber: | 7322357767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 08/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 043579 | CT | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0805X | 043579 | CT | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | 2084P0800X | 25MA09827200 | NJ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 001435791 | 05 | CT | MEDICAID | 260004885 | 01 | CT | MEDICARE PTAN | OTHER | 35960 | 01 | CT | CONTROLLED SUBSTANCE REG. | OTHER | 06-1483276 | 01 | CT | GROUP TAX ID. | OTHER | 001435793 | 05 | CT | MEDICAID | C02270 | 01 | CT | GROUP MEDICARE ID. | OTHER |