Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 25MA09653300 | NJ |
Y | 111NI0900X | Internist | 25MA09653300 | NJ |
NPI | 1003059866 |
---|---|
Provider Name | Shagufta Ahsan |
First Address | Cherry Hill, NJ 08003-2535 |
Second Address | Cherry Hill, NJ 08003-2535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2009 |
Last Update Date | 30/07/2020 |