Provider Demographics
NPI:1700012804
Name:M. FARRUKH NIZAM, MD, LLC
Entity Type:Organization
Organization Name:M. FARRUKH NIZAM, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:FARRUKH
Authorized Official - Last Name:NIZAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-494-0100
Mailing Address - Street 1:98 JAMES ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3902
Mailing Address - Country:US
Mailing Address - Phone:732-494-0100
Mailing Address - Fax:732-494-0114
Practice Address - Street 1:98 JAMES ST
Practice Address - Street 2:SUITE 301
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3902
Practice Address - Country:US
Practice Address - Phone:732-494-0100
Practice Address - Fax:732-494-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2084N0400X, 2084N0402X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty