Provider Demographics
NPI:1699823328
Name:TANTAWI, MAHNAZ CHAND (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHNAZ
Middle Name:CHAND
Last Name:TANTAWI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:177 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1311
Mailing Address - Country:US
Mailing Address - Phone:201-983-2455
Mailing Address - Fax:201-487-2126
Practice Address - Street 1:383 MARKET ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5300
Practice Address - Country:US
Practice Address - Phone:201-712-7900
Practice Address - Fax:201-712-7902
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA07672700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI31980Medicare UPIN