Provider Demographics
NPI:1033755921
Name:WAQAS, MOHAMMAD (FNP)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:WAQAS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NEW RD APT B16
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2297
Mailing Address - Country:US
Mailing Address - Phone:609-665-1257
Mailing Address - Fax:
Practice Address - Street 1:28 S NEW YORK RD STE C4
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9712
Practice Address - Country:US
Practice Address - Phone:609-652-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00989600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner