Provider Demographics
NPI:1821019373
Name:QURESHI, SHAUKAT M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAUKAT
Middle Name:M
Last Name:QURESHI
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 1:250 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-2700
Mailing Address - Country:US
Mailing Address - Phone:856-678-4452
Mailing Address - Fax:856-678-3325
Practice Address - Street 1:250 S BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-2700
Practice Address - Country:US
Practice Address - Phone:856-678-4452
Practice Address - Fax:856-678-3325
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA036255208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3753713BOtherCIGNA
NJ2243903Medicaid
NJ2243903Medicaid
NJQU174194Medicare ID - Type Unspecified