Provider Demographics
NPI:1992831929
Name:NOAZ, GOLAM G (MD)
Entity Type:Individual
Prefix:DR
First Name:GOLAM
Middle Name:G
Last Name:NOAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 BUCKINGHAM DRIVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3200
Mailing Address - Country:US
Mailing Address - Phone:732-542-6738
Mailing Address - Fax:732-542-1654
Practice Address - Street 1:1 INDUSTRIAL WAY WEST
Practice Address - Street 2:SUITE C
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2255
Practice Address - Country:US
Practice Address - Phone:732-542-6451
Practice Address - Fax:732-542-1654
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02966700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2015706Medicaid
NJ705704Medicare UPIN