Provider Demographics
NPI:1487834743
Name:KISHWAR SHAREEF MD PC
Entity Type:Organization
Organization Name:KISHWAR SHAREEF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KISHWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAREEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-442-3016
Mailing Address - Street 1:30 EDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-1973
Mailing Address - Country:US
Mailing Address - Phone:973-442-3016
Mailing Address - Fax:973-442-3017
Practice Address - Street 1:447 ROUTE 10 E
Practice Address - Street 2:15
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2132
Practice Address - Country:US
Practice Address - Phone:973-442-3016
Practice Address - Fax:973-442-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07099200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0056561Medicaid
NJ0056561Medicaid