Provider Demographics
NPI:1306841283
Name:OSMAN, IHSAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:IHSAN
Middle Name:A
Last Name:OSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 YATES RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8392
Mailing Address - Country:US
Mailing Address - Phone:732-679-6006
Mailing Address - Fax:732-679-7177
Practice Address - Street 1:1 IRENE CT
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2705
Practice Address - Country:US
Practice Address - Phone:732-679-6066
Practice Address - Fax:732-679-7177
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA450292080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55508Medicare UPIN