Provider Demographics
NPI:1295756401
Name:AL OLA, ZIYAD (MD)
Entity type:Individual
Prefix:
First Name:ZIYAD
Middle Name:
Last Name:AL OLA
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 1:140 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1847
Mailing Address - Country:US
Mailing Address - Phone:201-447-3603
Mailing Address - Fax:201-447-5184
Practice Address - Street 1:140 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1847
Practice Address - Country:US
Practice Address - Phone:201-447-3603
Practice Address - Fax:201-447-5184
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08268700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ333706WC0Medicare PIN
VA100452602OtherFEDERAL BLACK LUNG
WV3810013228Medicaid
VA018362W10Medicare PIN
VAP00660034Medicare PIN
NYDD6175Medicare ID - Type Unspecified
VA7611605OtherAETNA
WV1074042OtherBRICKSTREET (WV COMP)