Basic Information
Provider Information
NPI: 1497738801
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SECKIN
FirstName: ALI
MiddleName: INANC
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 18914
Address2:  
City: NEWARK
State: NJ
PostalCode: 071918914
CountryCode: US
TelephoneNumber: 2014880066
FaxNumber: 2014886769
Practice Location
Address1: 30 PROSPECT AVE
Address2:  
City: HACKENSACK
State: NJ
PostalCode: 076011914
CountryCode: US
TelephoneNumber: 2014880066
FaxNumber: 2014886769
Other Information
ProviderEnumerationDate: 11/21/2005
LastUpdateDate: 05/21/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X25MA07745200NJN Allopathic & Osteopathic PhysiciansAnesthesiology 
207LP2900X25MA07745200NJY Allopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine

ID Information
IDTypeStateIssuerDescription
007183805NJ MEDICAID
0264510505NY MEDICAID
P0026556001 RAILROAD MEDICAREOTHER


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