Provider Demographics
NPI:1619386414
Name:MAHMOOD, TARIQ (MD, FNP)
Entity Type:Individual
Prefix:MR
First Name:TARIQ
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:MD, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 ACADEMY ST
Mailing Address - Street 2:207
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2456
Mailing Address - Country:US
Mailing Address - Phone:201-218-8422
Mailing Address - Fax:
Practice Address - Street 1:203 ACADEMY ST
Practice Address - Street 2:207
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2456
Practice Address - Country:US
Practice Address - Phone:201-218-8422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00508100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily