Provider Demographics
NPI:1508816729
Name:ABIDI, S MANZOOR (MD)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:MANZOOR
Last Name:ABIDI
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 1:504 ROUTE 38 E
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052
Mailing Address - Country:US
Mailing Address - Phone:856-866-0466
Mailing Address - Fax:856-727-1483
Practice Address - Street 1:504 ROUTE 38 E
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052
Practice Address - Country:US
Practice Address - Phone:856-866-0466
Practice Address - Fax:856-727-1483
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0250822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3670503Medicaid
NJ401754AT5Medicare ID - Type Unspecified
C58033Medicare UPIN