Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 25MA03126100 | NJ |
NPI | 1184831455 |
---|---|
Provider Name | Dr. Sirajuddin Sheikh |
First Address | Ewing, NJ 08628-2016 |
Second Address | Ewing, NJ 08618-2669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 07/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4947606 | (05) | NJ |
P00769698 | RR MEDICARE (01) | NJ |