Provider Demographics
NPI:1316146541
Name:REJJAL, ABDELLATIF (MD)
Entity type:Individual
Prefix:
First Name:ABDELLATIF
Middle Name:
Last Name:REJJAL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:KING FAISAL SPECIALIST HOSPITAL
Mailing Address - Street 2:PO BOX 3354 MBC 58
Mailing Address - City:RIYADH
Mailing Address - State:RIYADH
Mailing Address - Zip Code:11211
Mailing Address - Country:SA
Mailing Address - Phone:0119661-442-6256
Mailing Address - Fax:0119661-442-7784
Practice Address - Street 1:110 REHILL AVE
Practice Address - Street 2:NEONATOLOGY DIVESION
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2519
Practice Address - Country:US
Practice Address - Phone:609-584-6762
Practice Address - Fax:609-584-5917
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA035916002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0141071Medicaid
NJ158984CY4Medicare PIN