Provider Demographics
NPI:1083640627
Name:RAZZAK, MANNAN (MD)
Entity Type:Individual
Prefix:
First Name:MANNAN
Middle Name:
Last Name:RAZZAK
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 1:205 BROWERTOWN RD
Mailing Address - Street 2:SUITE 001
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2671
Mailing Address - Country:US
Mailing Address - Phone:973-582-0644
Mailing Address - Fax:973-582-0605
Practice Address - Street 1:205 BROWERTOWN RD
Practice Address - Street 2:SUITE 001
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2671
Practice Address - Country:US
Practice Address - Phone:973-582-0644
Practice Address - Fax:973-582-0605
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA079395208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096651MWHMedicare Oscar/Certification
NJ096651RRAMedicare ID - Type UnspecifiedCLARA MAASS
NJI46958Medicare UPIN