Provider Demographics
NPI:1942578497
Name:RAZA, MOHAMMED H (DPT)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:H
Last Name:RAZA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CLYDE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5037
Mailing Address - Country:US
Mailing Address - Phone:732-649-3919
Mailing Address - Fax:732-649-3802
Practice Address - Street 1:2 WORLDS FAIR DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1369
Practice Address - Country:US
Practice Address - Phone:732-537-0909
Practice Address - Fax:732-564-9032
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01428600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3891278000OtherAMERIHEALTH
NJ1942578497Medicare PIN