Provider Demographics
NPI:1790739423
Name:SHARIM, IRADJ (MD)
Entity Type:Individual
Prefix:
First Name:IRADJ
Middle Name:
Last Name:SHARIM
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 1:40 FULD ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-5247
Mailing Address - Country:US
Mailing Address - Phone:609-393-4911
Mailing Address - Fax:
Practice Address - Street 1:40 FULD ST
Practice Address - Street 2:SUITE 402
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-5247
Practice Address - Country:US
Practice Address - Phone:609-393-4911
Practice Address - Fax:609-394-6770
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2958406Medicaid
NJ2958406Medicaid
NJSH123277Medicare ID - Type Unspecified