Provider Demographics
NPI:1538121926
Name:HAQUE, NADEEM UL (MD)
Entity Type:Individual
Prefix:
First Name:NADEEM
Middle Name:UL
Last Name:HAQUE
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:PO BOX 1807
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1807
Mailing Address - Country:US
Mailing Address - Phone:201-823-4400
Mailing Address - Fax:201-471-7545
Practice Address - Street 1:631 BROADWAY
Practice Address - Street 2:SUITE# B-2, 2ND FLOOR REAR
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3846
Practice Address - Country:US
Practice Address - Phone:201-823-4400
Practice Address - Fax:201-471-7545
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7233604Medicaid
NJ7233604Medicaid
G22812Medicare UPIN