Provider Demographics
NPI:1720316367
Name:DAFTANI, MOHAMMAD DAOUD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:DAOUD
Last Name:DAFTANI
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 1:24 VANDELFT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2335
Mailing Address - Country:US
Mailing Address - Phone:732-881-1124
Mailing Address - Fax:
Practice Address - Street 1:799 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1367
Practice Address - Country:US
Practice Address - Phone:973-746-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08685700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine