Provider Demographics
NPI:1073606109
Name:BANGASH, MAHMUD (MD)
Entity Type:Individual
Prefix:
First Name:MAHMUD
Middle Name:
Last Name:BANGASH
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 1:10-14 SADDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5728
Mailing Address - Country:US
Mailing Address - Phone:201-794-3256
Mailing Address - Fax:201-794-6457
Practice Address - Street 1:10-14 SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5728
Practice Address - Country:US
Practice Address - Phone:201-794-3256
Practice Address - Fax:201-794-6457
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0247652086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2670909Medicaid
NJ2670909Medicaid
526198Medicare PIN