Provider Demographics
NPI:1104827484
Name:KURESHI, MAKBULMIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:MAKBULMIAN
Middle Name:
Last Name:KURESHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3157
Mailing Address - Country:US
Mailing Address - Phone:856-848-4998
Mailing Address - Fax:856-853-7362
Practice Address - Street 1:748 KINGS HWY
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3157
Practice Address - Country:US
Practice Address - Phone:856-848-4998
Practice Address - Fax:856-853-7362
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA275912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0766305Medicaid
NJ0766305Medicaid
C54081Medicare UPIN