Provider Demographics
NPI:1609012525
Name:NUDRAT F AYUB MD LLC
Entity Type:Organization
Organization Name:NUDRAT F AYUB MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NUDRAT
Authorized Official - Middle Name:F
Authorized Official - Last Name:AYUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-926-3444
Mailing Address - Street 1:166 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2016
Mailing Address - Country:US
Mailing Address - Phone:973-926-3444
Mailing Address - Fax:
Practice Address - Street 1:166 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2016
Practice Address - Country:US
Practice Address - Phone:973-926-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08288800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty