Provider Demographics
NPI:1407303621
Name:SHAHBAKHT, MUHAMMAD
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:
Last Name:SHAHBAKHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 US HIGHWAY 1 S
Mailing Address - Street 2:BUILDING A
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-3009
Mailing Address - Country:US
Mailing Address - Phone:732-750-0400
Mailing Address - Fax:732-602-0749
Practice Address - Street 1:485 US HIGHWAY 1 S
Practice Address - Street 2:BUILDING A
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-3009
Practice Address - Country:US
Practice Address - Phone:732-750-0400
Practice Address - Fax:732-602-0749
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00669600152W00000X
NY008519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist