Provider Demographics
NPI:1598756173
Name:GILANI, ASIM HAIDER (MD)
Entity Type:Individual
Prefix:
First Name:ASIM
Middle Name:HAIDER
Last Name:GILANI
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 1:459 JACK MARTIN BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7724
Mailing Address - Country:US
Mailing Address - Phone:732-785-1000
Mailing Address - Fax:732-785-1222
Practice Address - Street 1:459 JACK MARTIN BLVD
Practice Address - Street 2:STE 1
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7724
Practice Address - Country:US
Practice Address - Phone:732-785-1000
Practice Address - Fax:732-785-1222
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07625900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001431101Medicaid
NJ072847P6RMedicare PIN
NJP00110552Medicare PIN
NJH93054Medicare UPIN