Provider Demographics
NPI:1710941836
Name:AYUB, MUHAMMED GAUHAR (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMED
Middle Name:GAUHAR
Last Name:AYUB
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 1:400 OSBORNE TER
Mailing Address - Street 2:SUITE L4
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2046
Mailing Address - Country:US
Mailing Address - Phone:973-926-7472
Mailing Address - Fax:973-923-8063
Practice Address - Street 1:400 OSBORNE TER
Practice Address - Street 2:SUITE L4
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2046
Practice Address - Country:US
Practice Address - Phone:973-926-7472
Practice Address - Fax:973-923-8063
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7588003Medicaid
NJAY813461Medicare ID - Type Unspecified
NJ7588003Medicaid