1154340842 NPI number — SHAHID MAHMOOD M.D.

Table of content: SHAHID MAHMOOD M.D. (NPI 1154340842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154340842 NPI number — SHAHID MAHMOOD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHMOOD
Provider First Name:
SHAHID
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:
1154340842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 ELLINGTON PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD CLIFFS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07632-2014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-951-7233
Provider Business Mailing Address Fax Number:
201-816-9431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 JACKSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07016-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-272-0699
Provider Business Practice Location Address Fax Number:
908-272-1478
Provider Enumeration Date:
07/19/2006

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: 174400000X , with the licence number:  25MA05915400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2747293000 . This is a "AMERIHEALTH #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 100070 . This is a "AMERIGROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7803401 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017635700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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