Provider Demographics
NPI:1164449724
Name:SAHU, SHARAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARAD
Middle Name:
Last Name:SAHU
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 1:211 ESSEX ST STE 303
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3246
Mailing Address - Country:US
Mailing Address - Phone:201-820-3372
Mailing Address - Fax:201-820-3374
Practice Address - Street 1:211 ESSEX ST STE 303
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3246
Practice Address - Country:US
Practice Address - Phone:201-820-3372
Practice Address - Fax:201-820-3374
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07619200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0005720Medicaid
NJ071090Medicare ID - Type Unspecified
NJ0005720Medicaid