Provider Demographics
NPI:1215370028
Name:QURESHI, MAHAM
Entity Type:Individual
Prefix:
First Name:MAHAM
Middle Name:
Last Name:QURESHI
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 1:199 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2409
Mailing Address - Country:US
Mailing Address - Phone:201-567-8008
Mailing Address - Fax:201-567-3003
Practice Address - Street 1:199 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2409
Practice Address - Country:US
Practice Address - Phone:201-567-8999
Practice Address - Fax:201-567-3003
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09869600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine