Provider Demographics
NPI:1841206208
Name:PERVEEN, MAHMOODAH (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOODAH
Middle Name:
Last Name:PERVEEN
Suffix:
Gender:F
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 459
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830
Mailing Address - Country:US
Mailing Address - Phone:201-858-8700
Mailing Address - Fax:201-436-7825
Practice Address - Street 1:534 AVENUE E STE 1D
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3987
Practice Address - Country:US
Practice Address - Phone:201-858-8700
Practice Address - Fax:201-436-7825
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06978000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8033803Medicaid
H04503Medicare UPIN
NJ8033803Medicaid