Provider Demographics
NPI:1083947741
Name:PATHAN, NUSRAT FATIMA (MD)
Entity Type:Individual
Prefix:
First Name:NUSRAT
Middle Name:FATIMA
Last Name:PATHAN
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 1:27 ASHLEY CT
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7270
Mailing Address - Country:US
Mailing Address - Phone:203-512-6259
Mailing Address - Fax:
Practice Address - Street 1:6308 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-5506
Practice Address - Country:US
Practice Address - Phone:203-512-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT47227207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0214884Medicaid
NJ0214884Medicaid