Provider Demographics
NPI:1326145764
Name:NIZAM, MOHAMMED FARRUKH (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:FARRUKH
Last Name:NIZAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:98 JAMES STREET, SUITE 301
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:732-738-8830
Mailing Address - Fax:732-738-8831
Practice Address - Street 1:98 JAMES STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-738-8830
Practice Address - Fax:732-738-8831
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA0651652084N0600X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG75095Medicare UPIN