Provider Demographics
NPI:1669658084
Name:MOKHASHI, SAJIDA HABIB (MD)
Entity Type:Individual
Prefix:
First Name:SAJIDA
Middle Name:HABIB
Last Name:MOKHASHI
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 1:51 KINGLET DR S STE 107
Mailing Address - Street 2:
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-2133
Mailing Address - Country:US
Mailing Address - Phone:120-198-8987
Mailing Address - Fax:
Practice Address - Street 1:400 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-9591
Practice Address - Country:US
Practice Address - Phone:732-851-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08324700207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0188735Medicaid
NJ0188735Medicaid