Basic Information
| Provider Information | |||||||||
| NPI: | 1629195748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AKHTAR | ||||||||
| FirstName: | REZA | ||||||||
| MiddleName: | YASIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1907 HWY 35 | ||||||||
| Address2: | SUITE #1 | ||||||||
| City: | OAKHURST | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077552765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325170060 | ||||||||
| FaxNumber: | 7325487408 | ||||||||
| Practice Location | |||||||||
| Address1: | 1907 HWY 35 | ||||||||
| Address2: | SUITE #1 | ||||||||
| City: | OAKHURST | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077552765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325170060 | ||||||||
| FaxNumber: | 7325487408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 03/31/2016 | ||||||||
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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 | 207R00000X | 25MA08917800 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 25MA08917800 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.