Provider Demographics
NPI:1427068857
Name:OBEIDALLAH, NASER M (RPH)
Entity type:Individual
Prefix:MR
First Name:NASER
Middle Name:M
Last Name:OBEIDALLAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2709
Mailing Address - Country:US
Mailing Address - Phone:973-249-6680
Mailing Address - Fax:973-389-2315
Practice Address - Street 1:214 HALEDON AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:NJ
Practice Address - Zip Code:07508-2024
Practice Address - Country:US
Practice Address - Phone:973-389-1311
Practice Address - Fax:973-389-2315
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02500600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02500600OtherNJ LICENSE #