Provider Demographics
NPI:1053711929
Name:ALLY HOUSECALL PHYSICIANS, P.C.
Entity type:Organization
Organization Name:ALLY HOUSECALL PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEID
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-367-6436
Mailing Address - Street 1:58 DOWNING LN
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4177
Mailing Address - Country:US
Mailing Address - Phone:609-560-8474
Mailing Address - Fax:856-874-9399
Practice Address - Street 1:58 DOWNING LN
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4177
Practice Address - Country:US
Practice Address - Phone:609-367-6436
Practice Address - Fax:856-874-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05554200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4590503Medicaid
NJ672910YBAWMedicare PIN
NJ672910R63Medicare PIN
NJE71634Medicare UPIN