Provider Demographics
NPI:1235504309
Name:RIFAT, SHAHZAD SULTAN (APN)
Entity Type:Individual
Prefix:MR
First Name:SHAHZAD
Middle Name:SULTAN
Last Name:RIFAT
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 CONNOLLY DR
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08850-2103
Mailing Address - Country:US
Mailing Address - Phone:732-470-1070
Mailing Address - Fax:
Practice Address - Street 1:695 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7200
Practice Address - Country:US
Practice Address - Phone:908-688-6565
Practice Address - Fax:908-688-3161
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00603800363LA2100X, 363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology