Provider Demographics
NPI:1477810752
Name:ABBASI, SHAHED
Entity Type:Individual
Prefix:
First Name:SHAHED
Middle Name:
Last Name:ABBASI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BERGEN ST
Mailing Address - Street 2:UH-H245
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2496
Mailing Address - Country:US
Mailing Address - Phone:973-972-5672
Mailing Address - Fax:973-972-0365
Practice Address - Street 1:150 BERGEN ST
Practice Address - Street 2:UH-H245
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2496
Practice Address - Country:US
Practice Address - Phone:973-972-5672
Practice Address - Fax:973-972-0365
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09712900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine