Provider Demographics
NPI:1881648541
Name:HAQ, MEHNAZ A (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHNAZ
Middle Name:A
Last Name:HAQ
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 1:2648 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1021
Mailing Address - Country:US
Mailing Address - Phone:732-951-8585
Mailing Address - Fax:732-951-9112
Practice Address - Street 1:2648 ROUTE 27
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1021
Practice Address - Country:US
Practice Address - Phone:732-951-8585
Practice Address - Fax:732-951-9112
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06414600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7162405Medicaid
NJHA894315Medicare ID - Type Unspecified
NJ7162405Medicaid