Provider Demographics
NPI:1770511818
Name:RAHMAN, MAHBOOB U (MD)
Entity Type:Individual
Prefix:
First Name:MAHBOOB
Middle Name:U
Last Name:RAHMAN
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:PO BOX 2697
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08362-2697
Mailing Address - Country:US
Mailing Address - Phone:856-794-9090
Mailing Address - Fax:856-794-3058
Practice Address - Street 1:125 PATERSON ST
Practice Address - Street 2:ROOM/FLOOR 5200A
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1962
Practice Address - Country:US
Practice Address - Phone:732-235-7217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06184100207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013937650001Medicaid
PA198950Medicare PIN
G16801Medicare UPIN