Provider Demographics
NPI:1477940872
Name:ABDULHAKEEM, ABDURRAHMAN
Entity Type:Individual
Prefix:
First Name:ABDURRAHMAN
Middle Name:
Last Name:ABDULHAKEEM
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 1:492 PARK AVE
Mailing Address - Street 2:APT2
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-2590
Mailing Address - Country:US
Mailing Address - Phone:862-252-0858
Mailing Address - Fax:862-252-8808
Practice Address - Street 1:492 PARK AVE
Practice Address - Street 2:APT2
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-2590
Practice Address - Country:US
Practice Address - Phone:862-252-0858
Practice Address - Fax:862-252-8808
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ102777146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic