Provider Demographics
NPI:1528037272
Name:KHUDDUS, MUNAWARA SHAHNAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MUNAWARA
Middle Name:SHAHNAZ
Last Name:KHUDDUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1536
Mailing Address - Country:US
Mailing Address - Phone:732-739-1908
Mailing Address - Fax:732-739-1565
Practice Address - Street 1:51 VILLAGE CT
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1536
Practice Address - Country:US
Practice Address - Phone:732-739-1908
Practice Address - Fax:732-739-1565
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40134208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics