Provider Demographics
NPI:1073883229
Name:BAKERYWALA, SUHALIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUHALIA
Middle Name:
Last Name:BAKERYWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 WYCKOFF AVE STE 389
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1438
Mailing Address - Country:US
Mailing Address - Phone:914-255-1333
Mailing Address - Fax:
Practice Address - Street 1:385 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1934
Practice Address - Country:US
Practice Address - Phone:551-209-3555
Practice Address - Fax:551-236-2555
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09870400207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism