Provider Demographics
NPI:1518261882
Name:GHAFOOR, SADIA K
Entity Type:Individual
Prefix:
First Name:SADIA
Middle Name:K
Last Name:GHAFOOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SADIA
Other - Middle Name:K
Other - Last Name:CHAUDHRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3947
Mailing Address - Country:US
Mailing Address - Phone:732-321-7010
Mailing Address - Fax:732-744-5873
Practice Address - Street 1:65 JAMES ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3947
Practice Address - Country:US
Practice Address - Phone:732-321-7010
Practice Address - Fax:732-744-5873
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00254800363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS400205905Medicare PIN
NJ225845Medicare PIN