1013605096 NPI number — MUHAMMAD EHTESHAM JAVED M.D

Table of content: MUHAMMAD EHTESHAM JAVED M.D (NPI 1013605096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013605096 NPI number — MUHAMMAD EHTESHAM JAVED M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAVED
Provider First Name:
MUHAMMAD EHTESHAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013605096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/29/2023
NPI Reactivation Date:
05/23/2024

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RUTGERS JERSEY CITY OF MEDICAL CENTER
Provider Second Line Business Mailing Address:
355 GRAND STREET, DEPARTMENT OF MEDICINE 1 EAST
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
332-179-0407
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RUTGERS JERSEY CITY OF MEDICAL CENTER
Provider Second Line Business Practice Location Address:
355 GRAND STREET, DEPARTMENT OF MEDICINE 1 EAST
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-915-2219
Provider Business Practice Location Address Fax Number:
201-915-2219
Provider Enumeration Date:
04/27/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)