Provider Demographics
NPI:1447277918
Name:RIZVI, TARIQ AHMAD (MD)
Entity type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:AHMAD
Last Name:RIZVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 VERONICA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5002
Mailing Address - Country:US
Mailing Address - Phone:732-828-0002
Mailing Address - Fax:732-828-7070
Practice Address - Street 1:75 VERONICA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5002
Practice Address - Country:US
Practice Address - Phone:732-828-0002
Practice Address - Fax:732-828-7070
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ686170M26Medicare ID - Type Unspecified
NJG21482Medicare UPIN