Provider Demographics
NPI:1225124738
Name:SHAD, ABDUR RAUF (MD)
Entity Type:Individual
Prefix:
First Name:ABDUR
Middle Name:RAUF
Last Name:SHAD
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:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-0174
Mailing Address - Country:US
Mailing Address - Phone:201-967-8425
Mailing Address - Fax:201-967-8443
Practice Address - Street 1:131 MADISON AVENUE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7360
Practice Address - Country:US
Practice Address - Phone:973-309-4324
Practice Address - Fax:973-587-0303
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07564400207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0180114Medicaid