Provider Demographics
NPI:1114983541
Name:MASUD, AVAIS (MD)
Entity Type:Individual
Prefix:DR
First Name:AVAIS
Middle Name:
Last Name:MASUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WAUIS
Other - Middle Name:
Other - Last Name:MASUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2100 CORLIES AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6102
Mailing Address - Country:US
Mailing Address - Phone:732-988-8228
Mailing Address - Fax:732-451-0059
Practice Address - Street 1:2100 CORLIES AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6102
Practice Address - Country:US
Practice Address - Phone:732-988-8228
Practice Address - Fax:732-451-0059
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07052800207RN0300X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ83C9305Medicaid
NJ2K7625OtherHEALTH NET
NJ2K7625OtherHEALTH NET
NJ037996B7DMedicare ID - Type Unspecified