Provider Demographics
NPI:1619912102
Name:AKHTAR, SHAHNAZ (MD)
Entity Type:Individual
Prefix:
First Name:SHAHNAZ
Middle Name:
Last Name:AKHTAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4603
Mailing Address - Country:US
Mailing Address - Phone:201-339-1685
Mailing Address - Fax:201-339-2557
Practice Address - Street 1:16 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4603
Practice Address - Country:US
Practice Address - Phone:201-339-1685
Practice Address - Fax:201-339-2557
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8390401Medicaid
044590Medicare ID - Type Unspecified
H30100Medicare UPIN