Provider Demographics
NPI:1578558847
Name:ABUBAKAR, SHAIK (MD)
Entity Type:Individual
Prefix:
First Name:SHAIK
Middle Name:
Last Name:ABUBAKAR
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 1:452 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2727
Mailing Address - Country:US
Mailing Address - Phone:201-222-0821
Mailing Address - Fax:201-222-1018
Practice Address - Street 1:452 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-2727
Practice Address - Country:US
Practice Address - Phone:201-222-0821
Practice Address - Fax:201-222-1018
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA053582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5315701Medicaid
668570Medicare ID - Type Unspecified
NJ5315701Medicaid