Provider Demographics
NPI:1780675058
Name:QURAISHI, ASMAT ULLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ASMAT
Middle Name:ULLAH
Last Name:QURAISHI
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 1:315 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3442
Mailing Address - Country:US
Mailing Address - Phone:201-837-2174
Mailing Address - Fax:201-836-7838
Practice Address - Street 1:315 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3442
Practice Address - Country:US
Practice Address - Phone:201-837-2174
Practice Address - Fax:201-836-7838
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39257174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC60957Medicare UPIN
NJ462612BMKMedicare PIN