Provider Demographics
NPI:1164803714
Name:TARIQ, SAMREEN
Entity Type:Individual
Prefix:DR
First Name:SAMREEN
Middle Name:
Last Name:TARIQ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3821
Mailing Address - Country:US
Mailing Address - Phone:201-436-2800
Mailing Address - Fax:201-436-1353
Practice Address - Street 1:622 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3821
Practice Address - Country:US
Practice Address - Phone:201-436-2800
Practice Address - Fax:201-436-1353
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10422400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty