Provider Demographics
NPI:1265442875
Name:MIRZA, BABAR (MD)
Entity type:Individual
Prefix:
First Name:BABAR
Middle Name:
Last Name:MIRZA
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 1:32 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1429
Mailing Address - Country:US
Mailing Address - Phone:732-462-4100
Mailing Address - Fax:732-462-4549
Practice Address - Street 1:42 THROCKMORTON LN
Practice Address - Street 2:2ND FLOOR
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2572
Practice Address - Country:US
Practice Address - Phone:732-607-1111
Practice Address - Fax:732-607-0552
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA049580174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5288100Medicaid
NJMI031798OtherMEDICARE ID TYPE UNSPECIFIED
NJ5288100Medicaid