Provider Demographics
NPI:1033290242
Name:MOHAMMAD, SAJJAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SAJJAD
Middle Name:
Last Name:MOHAMMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 HEMLOCK TER
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6413
Mailing Address - Country:US
Mailing Address - Phone:646-523-0472
Mailing Address - Fax:
Practice Address - Street 1:40 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4808
Practice Address - Country:US
Practice Address - Phone:212-233-5033
Practice Address - Fax:212-233-0855
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY201036174400000X
NY201036207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02080844Medicaid
NY00695941Medicaid
NYHO9113Medicare UPIN
NY331954Medicare Oscar/Certification
NY02080844Medicaid
NY837782Medicare PIN