Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | MA065165 | NJ |
N | 2084N0600X | Clinical Neurophysiologist | MA065165 | NJ |
NPI | 1326145764 |
---|---|
Provider Name | Dr. Mohammed Farrukh Nizam |
First Address | Edison, NJ 08820-3902 |
Second Address | Edison, NJ 08820-3902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 07/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G75095 | (02) | NJ |