Provider Demographics
NPI:1659348142
Name:SHAREEF, KISHWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHWAR
Middle Name:
Last Name:SHAREEF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KISHWAR
Other - Middle Name:
Other - Last Name:AYUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:447 ROUTE 10 E
Mailing Address - Street 2:SUITE 15
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2132
Mailing Address - Country:US
Mailing Address - Phone:973-442-3016
Mailing Address - Fax:973-442-3017
Practice Address - Street 1:447 ROUTE 10 E
Practice Address - Street 2:SUITE 15
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2132
Practice Address - Country:US
Practice Address - Phone:973-442-3016
Practice Address - Fax:973-442-3017
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07099200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0056561Medicaid
NJ0056561Medicaid
NJ079509TS6Medicare PIN