Provider Demographics
NPI:1093711947
Name:KADRI, IFTEKHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:IFTEKHAR
Middle Name:
Last Name:KADRI
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 1:15 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1211
Mailing Address - Country:US
Mailing Address - Phone:973-736-2600
Mailing Address - Fax:973-736-8355
Practice Address - Street 1:372 VALLEY RD
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5303
Practice Address - Country:US
Practice Address - Phone:973-736-2600
Practice Address - Fax:973-736-8355
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA43002207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1190202Medicaid
NJ1190202Medicaid
NJC55100Medicare UPIN