Provider Demographics
NPI:1457491599
Name:ISLAM, JAVEDUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAVEDUL
Middle Name:
Last Name:ISLAM
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 1:200 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2313
Mailing Address - Country:US
Mailing Address - Phone:973-882-0444
Mailing Address - Fax:973-882-3217
Practice Address - Street 1:200 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2313
Practice Address - Country:US
Practice Address - Phone:973-882-0444
Practice Address - Fax:973-882-3217
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07774600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI27511Medicare UPIN