Provider Demographics
NPI:1578505509
Name:SOLIMAN, ISHAK G (MD)
Entity Type:Individual
Prefix:
First Name:ISHAK
Middle Name:G
Last Name:SOLIMAN
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 1:140 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4797
Mailing Address - Country:US
Mailing Address - Phone:973-777-8900
Mailing Address - Fax:973-777-8929
Practice Address - Street 1:140 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4797
Practice Address - Country:US
Practice Address - Phone:973-777-8900
Practice Address - Fax:973-777-8929
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8368309Medicaid
020594309OtherGROUP TAX ID # (LLC-OWNER
G96257Medicare UPIN
NJ8368309Medicaid