Provider Demographics
NPI:1497106629
Name:LIAQAT, AIMEN
Entity Type:Individual
Prefix:
First Name:AIMEN
Middle Name:
Last Name:LIAQAT
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 1:115 OLD SHORT HILLS RD APT 570
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1211 UNION AVE STE 330
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6655
Practice Address - Country:US
Practice Address - Phone:901-478-9183
Practice Address - Fax:901-478-8957
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN64759207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ221494440OtherGME COORDINATOR