1699873463 NPI number — DR. WAMIQ SULTAN MD

Table of content: DR. WAMIQ SULTAN MD (NPI 1699873463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699873463 NPI number — DR. WAMIQ SULTAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULTAN
Provider First Name:
WAMIQ
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1699873463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3241 SARUM FARM LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNET VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19060-2258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-887-3005
Provider Business Mailing Address Fax Number:
856-759-4035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3241 SARUM FARM LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARNET VALLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19060-2258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-887-3005
Provider Business Practice Location Address Fax Number:
856-759-4035
Provider Enumeration Date:
09/20/2006

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: 207R00000X , with the licence number:  MA63364 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD-056420-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: MD-056420-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: MA63364 , 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: 0663772000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 19789 . This is a "UNIVERSITY HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223266219 041 . This is a "TRICARE CHAMPUS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1839600 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7516100 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: SA0000055 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3364422 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 356685 . This is a "PENNSYLVANIA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 356685 . This is a "AMERIHEALTH PPO PABS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P1273820 . This is a "OXFORD HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0595807 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1070758 . This is a "HORIZON- NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K6114 . This is a "HEALTHNET, INC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 130018460 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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