Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 024765 | NJ |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 024765 | NJ |
NPI | 1073606109 |
---|---|
Provider Name | Mahmud Bangash |
First Address | Fair Lawn, NJ 07410-5728 |
Second Address | Fair Lawn, NJ 07410-5728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 05/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2670909 | (05) | NJ |
C60285 | (02) |