Provider Demographics
NPI:1568547677
Name:SINGH, AVTAR (MD)
Entity Type:Individual
Prefix:MR
First Name:AVTAR
Middle Name:
Last Name:SINGH
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 1:401 HAMBURG TPKE STE 107
Mailing Address - Street 2:PO BOX 2336
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2139
Mailing Address - Country:US
Mailing Address - Phone:973-595-7456
Mailing Address - Fax:973-904-9119
Practice Address - Street 1:401 HAMBURG TURNPIKE
Practice Address - Street 2:SUITE 107
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-595-7456
Practice Address - Fax:973-904-9119
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39604207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1490508Medicaid
NJSI452183Medicare ID - Type Unspecified
NJ1490508Medicaid