Provider Demographics
NPI:1679521843
Name:MAHMOOD, TARIQ (MD)
Entity Type:Individual
Prefix:
First Name:TARIQ
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 MORRIS AVE
Mailing Address - Street 2:(SUITE D 4)
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5714
Mailing Address - Country:US
Mailing Address - Phone:908-688-8911
Mailing Address - Fax:908-688-8889
Practice Address - Street 1:2333 MORRIS AVE
Practice Address - Street 2:STE D204
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5718
Practice Address - Country:US
Practice Address - Phone:908-688-8911
Practice Address - Fax:908-688-8889
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04135300207KA0200X, 207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE53341Medicare UPIN